There are various styles of practice that reside under the heading of optometry or eye care.  Many optometrists are now practicing in a way that very closely resembles ophthalmology.  There are numerous issues to be addressed when looking at alternatives in vision care.  The two main categories of eye care providers are optometrists and ophthalmologists.  Both of these disciplines have evolved over the years.  Science marches on, providing new insights and new technologies.  Both professions have taken what they feel is useful and both tend to ignore things that seem to go against what they believe in.  There is also a tendency to look down upon, or even fear concepts they do not understand.  Professionals who focus on the physical aspects of the eyes have a strong tendency to ignore the functional aspects of the visual process.  Those who do claim to address functional issues do so in a very mechanical way.  This approach does not address the complex issues that permit the visual process to function smoothly.  It is up to each individual to inform themselves the best they can rather than depending on the advice of so-called experts.

The eyes are relatively simple organs whose structure is fairly well understood.  The visual process is extremely complex and not nearly so well understood.  Vision is a dynamic process.  Its purpose is to derive meaning, and direct action in response to light entering the eyes.  Good vision maximizes our potential in activities like reading, writing, working at a computer, arts and crafts, driving, and sports.  When there is any disturbance in the visual process, our performance suffers to some degree.  Vision is learned, and develops throughout our lives.  This means that either breakdown or enhancement can occur at any time.  There are many areas of the brain that come into play as the visual process functions.  The visual process is essentially one that involves the entire body as well.

Ophthalmology vs. Optometry

Ophthalmology is a specialty area within the practice of medicine devoted to diseases of the eye.  Ophthalmologists are medical doctors who diagnose and treat all diseases of the eye.  The typical choice of treatment begins with medications and/or surgery.  They are also permitted to prescribe lenses.  Optometry is a profession unto itself.  Optometrists are trained to diagnose all, and treat some diseases of the eye.  They are trained to prescribe lenses as well.  All optometrists are trained in recognizing and treating functional deficiencies, that is, eye teaming, focusing, and eye tracking problems to name a few.  The vast majority of optometrists and ophthalmologists choose not to place emphasis on such functional conditions.  This means that the majority of these problems go undiagnosed even in the face of obvious symptoms, complaints, and reduced ability to function.  It is not unusual for an individual suffering from these problems to be told that their eyes are fine.  Technically, this may be true.  The eyes themselves probably are healthy.  However, this does not mean that there is not a functional vision problem, one that can be diagnosed and treated by someone who is specially trained in this area - a behavioral optometrist.  Behavioral optometrists base their practices on the knowledge that vision is a dynamic process that develops throughout our lives.  The visual process is trainable, and can be enhanced using therapeutic lenses and/or Visual Training.

Compensation vs. Enhancement of performance

When a problem exists, various approaches are available.  Some approaches are aimed at compensating for the problem.  That is, finding a way to simulate the absence of a problem.  This type of approach deals with surface issues, the symptoms that have become outwardly noticeable.  Other approaches are aimed at attacking the root of the problem by dealing with the causes of the outward signs.  An example is nearsightedness, that condition where a person cannot see clearly in the distance without lenses.  Typically, nearsighted people are prescribed compensating lenses.  Compensating lenses are prescribed to help a person see clearly when this can seemingly no longer be achieved without lenses.  These lenses are usually called corrective lenses.  However, this is not an accurate description since they do not correct anything.  They serve to mask the focusing problem, and in fact, will help to worsen the condition over time, in most cases.  Lenses prescribed to enhance performance can actually help to improve the condition.  In order to prescribe such lenses, it is necessary to perform a thorough evaluation of total visual performance.  It is not sufficient to assure that the eyes are healthy and that the eye chart can be seen clearly.  An assessment of performance and comfort are necessary to assure the highest level of care. 
It is a fact that all lenses create perceptual and functional side effects.  That is, a person must respond in some way to having lenses on.  When this fact is taken into account, it can be used in a fairly predictable way to effect positive changes.  When ignored, the changes that result will also be somewhat predictable, but not usually positive.   The resulting side effects are almost always undesirable in the case of compensating lenses.  For some people the effects are minor, for some they are critical.  For example, a person who wears glasses all day long because of difficulty seeing far away is putting almost constant strain on their visual system and their eyes.  This is due to the fact that such lenses are designed for seeing things that are at least twenty feet away.  Anything that is closer than that distance requires that the visual system work much harder than it would without the glasses.  The closer the viewing distance the greater the strain on the visual system.  The longer this goes on, the more damage is done.  

Medical approach vs. Functional approach

In general, all ophthalmologists and the vast majority of optometrists utilize a medical approach to eye care, which means drugs, surgery and compensating lenses.  Behavioral optometrists evaluate the visual process, not just the eyes, within a functional framework.  The medical approach holds that all conditions are based either on heredity or on some mechanical breakdown.  Until quite recently it was not widely accepted that emotional states or stress could cause a wide variety of what seemed to be mechanical breakdowns.  The medical approach still tends to deal with these issues based on physical consequences.  The tendency is to focus strictly on the surface issues, those either mentioned by the patient or obvious to the doctor.  The problem is addressed by treating the apparent broken part or malfunction with medication or surgery.  This approach is the cornerstone of the compensating strategy previously mentioned.  It does not usually deal with the root of the problem, but tries to mask it by making things look good on the surface.  The functional approach looks at the dynamics of the situation by trying to find the root of the problem.  The condition is dealt with in a more thorough way, trying to eliminate those activities, substances, or behaviors that have led to some breakdown in performance and/or structure.  The functional approach considers most physical breakdowns to be a result of improper use of some sort.  This approach is much less likely to use drugs and surgery as a first choice in treatment.  Instead, some type of therapy will be used to bring about deeper changes.  The medical approach attempts to provide a “quick and easy” solution.  However, nothing comes without a price.  Most medications have side effects, some subtle, some obvious and all surgery is irreversible.  Surgery also has its own, sometimes subtle, side effects although this is not a widely acknowledged issue.
An example of this way of thinking would be nearsightedness, which on the surface means that a person cannot see far away as clearly as expected without wearing artificial lenses.  The medical approach believes this to be an inherited condition that cannot be helped.  Their only treatment is to prescribe compensating lenses, or more recently, to surgically alter the shape of the eye.  These treatments simply mask the fact that the person cannot see clearly.  The functional approach understands that most cases of nearsightedness result from improper use of the eyes.  Since this is a functional problem it can be treated in a way that can prevent or reverse the condition.  This can be done, in some cases, with therapeutic (rather than compensating) lenses and visual training.  The more subtle issues deal with the fact that people develop their nearsightedness naturally.  That is, the changes take place over time as a result of how a person deals with the visual demands they face throughout their lives.  Whatever inconveniences this may present, this is an organic process and must be treated in a more natural way whenever possible - and this turns out to be quite often.

Visual training

Visual training is a developmental/functional/behavioral approach to improving visually based performance.  Visually guided activities include reading, writing, driving, sports and all other activities involving eye/hand coordination.  The purpose of visual training is to provide opportunities to experience just how vision works under a variety of conditions, in response to different types of demands.  This enables the individual to observe and understand various aspects of visual behavior, and helps the brain to discover more effective, more comfortable styles of visual performance.  There are various approaches and styles to providing this type of treatment.

Originally, visual training was limited to what is known as “orthoptics.”  Orthoptics is limited to compensating lenses or prisms and a few “eye muscle exercises.”  Modern visual training is in no way limited to exercising eye muscles.  According to all medical standards of evaluating eye muscles there are only infrequent cases of faulty eye muscles.  This is even true of most people who have eye muscle surgery to cosmetically align the eyes.  In most of these cases there has been a breakdown of communication that has disrupted the ability of the brain to coordinate and integrate the eye muscles properly.  If caught early, many turned eyes can be straightened non-surgically.  The important thing is that when the eyes are straightened through visual training they not only look straight but they will be teaming better.  This almost never happens with simple cosmetic alignment of the eyes.  Vision occurs in the brain, and good visual training trains the brain to make better use of visual abilities, information processing and communication between various areas in the brain.  Some offices utilize computers for much of the training.  Generally, this means that the trainee is seated a short distance from a computer, and remains seated and basically motionless throughout the training session.  Research has shown that improvement of visual performance proceeds at a faster pace, with more comprehensive results if the subject combines physical activity with visual learning.  This cannot occur while sitting at a desk or in front of a computer.  State of the art visual training requires physical involvement, the dynamic use of lenses, and constant overseeing by the doctor, including dialogue - to increase the doctor's understanding of the person seeking help, and to increase the person's understanding of how they use, and can improve their visual process.

Lenses

Doctor vs. Technician

Most providers of visual training utilize therapists or technicians to provide the actual treatment, and in some cases, to create the program itself.  In many cases the treatment program is pre-arranged, and based strictly on a specific diagnosis.  This means that there is a “cookbook” approach; a certain diagnosis implies that a certain series of activities will cure the symptoms.  This can have a positive effect.  The elimination of symptoms can lead to improved performance and comfort.  However, there are more powerful, far-reaching benefits available from a more dynamic, in-depth approach to visual training.  Typically, in such technician-based practices, the doctor is not present other than for periodic re-evaluations.  There are significant limitations to the therapy process when the doctor is only periodically present.  Technicians tend to come and go which greatly interferes with the continuity of the treatment.  Even though some technicians have some formal training, it is unlikely that they will have the background or the insights of an experienced behavioral optometrist.  All but the most experienced technicians have limitations on their ability to handle unusual circumstances.  This means that they can only do what the cookbook allows even if this is not providing the optimal experiences for that individual, at that moment.  In very simple cases this may never become an issue.  In more complex situations this can be a major drawback.  When the doctor is providing the therapy this allows for much greater flexibility in dealing with each individual.  This maximizes the benefits available during each session, as well as over the course of the entire program. 

Splinter skills vs. Global performance enhancement