In the evolving landscape of optometry, behavioral binocular vision (BV) experts play a crucial role in reshaping how eye care professionals approach vision-related challenges. Traditional optometry has long focused on visual acuity, prescribing glasses and contact lenses to correct refractive errors. However, BV experts look beyond clarity of vision, addressing the underlying binocular dysfunctions that can impact daily life. Their approach is often misunderstood, with many perceiving it as unconventional or even “magic.” Yet, through rigorous training and clinical experience, BV specialists have demonstrated that their methodologies can significantly enhance patient outcomes.

One such expert is Dr. Amrit Bilkhu, a leading optometrist specializing in pediatric care and binocular vision. As co-owner of Northern Sight Optometry and a recognized authority in vision therapy, Dr. Bilkhu has dedicated her career to uncovering the root causes of binocular dysfunction and helping patients achieve optimal visual comfort. Her insights challenge conventional approaches and provide new pathways for managing pediatric vision care and myopia control.

Binocular vision is the ability of both eyes to work together as a coordinated system. Dysfunction in this system can lead to various symptoms, including headaches, eye strain, reading difficulties, and even behavioral issues in children. BV experts focus on diagnosing and treating these dysfunctions through a combination of specialized lenses, vision therapy, and functional optometric principles.

Dr. Amrit Bilkhu, a leading optometrist specializing in pediatric care and binocular vision, explains:
“What traditional optometry often misses is the reason behind a child’s refractive error. Instead of merely prescribing stronger lenses, we need to ask—why is their myopia progressing? Why does their visual system struggle with near work? Addressing these root causes allows us to make a real impact on their vision and overall well-being.”

Despite its effectiveness, BV optometry remains a niche area, often viewed skeptically by traditional practitioners. The divide stems from several factors:

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• Lack of Standard Protocols: Unlike conventional treatments for conditions like glaucoma or dry eye, BV therapies are highly individualized. Each patient’s visual system reacts differently, making it difficult to establish one-size-fits-all protocols.
  
  
• Limited Clinical Trials: BV treatments often rely on case studies and decades of clinical practice rather than large-scale randomized trials. This makes it challenging for evidence-based optometrists to fully embrace these methods.
  
  
• Specialized Training Requirements: Becoming proficient in BV requires extensive post-graduate education, workshops, and mentorship. Many optometrists may not have the time or resources to invest in this level of specialization.
  

Dr. Harbir Sian, shares his initial skepticism. “I used to think BV was this mysterious realm of optometry—something that only a select few understood. But once I started referring patients and seeing their progress, I realized there’s so much more to vision care than just 20/20 acuity.”

Many patients experience symptoms such as headaches, blurred vision, or double vision despite having a “perfect” prescription. BV experts analyze how the eyes function together, prescribing lenses that alleviate strain rather than merely maximizing acuity.

Children with reading difficulties, attention issues, or frequent prescription changes may benefit significantly from BV assessments. Traditional optometry often prescribes stronger lenses for myopic progression, whereas BV experts might recommend low-plus reading glasses or bifocals to reduce accommodative stress.

While mainstream myopia management focuses on atropine drops, ortho-k, and peripheral defocus lenses, BV optometrists take a functional approach. They prescribe reading glasses to alleviate near stress, potentially stabilizing or even reversing early myopia development.

Instead of solely relying on patching, BV specialists use techniques that enhance binocular function, often achieving better long-term outcomes. These approaches emphasize integration rather than suppression of the weaker eye.

Despite the reluctance of many traditional optometrists to embrace BV, increased education and collaboration can help bridge the gap. Dr. Bilkhu emphasizes:
“BV isn’t magic—it’s just a different way of looking at vision. The more primary care optometrists understand these concepts, the better equipped they’ll be to identify patients who need specialized care.”

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• Educate Yourself: Attend CE courses on BV and functional optometry principles.
  
  
• Trial Basic Techniques: Incorporate trial framing for near prescriptions and observe patient responses.
  
  
• Refer When Needed: Establish connections with local BV specialists for complex cases.
  
  
• Stay Open-Minded: Recognize that vision care extends beyond refractive error correction.
  

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