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Lady Cilento Children's Hospital

Behavioural optometrists barred by children's hospital

A children's hospital in Queensland has indicated it will not refer its patients to behavioural optometrists for collaborative care.

Despite the UNSW School of Optometry and Vision Science including behavioural optometry in its Master of Optometry postgraduate curriculum, the ophthalmology department at Lady Cilento Children's Hospital (LCCH) in Brisbane has barred Australasian College of Behavioural Optometrists (ACBO) members from its Paediatric Optometry Alignment Program (POAP).

POAP, which was launched this year, is a clinical education course designed to set the standards of eye care for optometrists seeking to co-manage patients from LCCH's ophthalmology department. Optometrists who complete the program are listed on the LCCH's website as being 'aligned' with the hospital, and are promoted to GPs as well as LCCH hospital staff.

When the program pilot was first announced, several eligibility requirements were specified. This list of eligibility criteria has since been updated to state that optometrists must "have no affiliation with ACBO, including membership, and do not identify with or otherwise practise or promote behavioural optometry services".

Elaborating on the decision to exclude behavioural optometrists in a statement, a Children's Health Queensland spokesperson said that while these practitioners claimed to be able to treat a range of conditions - including learning difficulties and the 'underachieving child', ADHD, behavioural problems, poor coordination and clumsiness - the ability of behavioural optometry to improve reading and learning performance had been "directly challenged by mainstream medical organisations".

The spokesperson cited a joint statement released in 2009 by the American Academy of Pediatrics, American Academy of Ophthalmology, American Association of Pediatric Ophthalmology and Strabismus, and the American Academy of Certified Orthoptists, which stated:

" problems are not the cause of primary dyslexia or learning disabilities. Scientific evidence does not support the efficacy of eye exercises, behavioural vision therapy, or special tinted filters or lenses for improving the long-term educational performance in these complex paediatric neurocognitive conditions.

"Diagnostic and treatment approaches that lack scientific evidence of efficacy, including eye exercises, behavioural vision therapy, or special tinted filters or lenses, are not endorsed and should not be recommended."

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The spokesperson added, "Further, in 2015, the American Academy of Pediatrics suggested that there is no indication to routinely refer children diagnosed with specific reading impairment to an ophthalmologist or optometrist, and that these children should have non-vision based support.

"The LCCH ophthalmology department has taken the position not to align with optometrists who practise behavioural optometry. However, we welcome optometrists who wish to join us in practising evidence-based care."

ACBO, whose membership is understood to comprise almost 400 optometrists, acknowledged the question of whether or not there is evidence that behavioural optometry works on its website.

"The concept of behavioural optometry is supported by a substantial body of research spanning many decades and continents," the website stated. "Clinical evidence is substantial and rigorous, and growing..."

The website also contains a list of references to statements and papers said to support the efficacy of behavioural optometry.

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