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Guidelines for the Certificate in Behavioural Optometry, leading to Fellowship of the Association

Introduction

The certificate in Behavioural Optometry is intended to be in recognition of evidence of further study and experience in the field of Behavioural Optometry. 

The Certification process would demonstrate further academic training, and examination of knowledge. Passing the course would be rewarded by the conferring of the letters FBABO –Fellow of the British Association of Behavioural Optometrists,

Nature of examination

Candidates will be required to prepare four open book questions, four case studies, and pass a multiple choice question exam and a viva.  Attendance of an advanced strabismus and amblyopia course (designated OVT4) is a requirement of the certification process.

Mentoring

Each candidate will be assigned a mentor to assist with study, give guidance and encouragement, and advise generally on the process to Fellowship.

Pre-requisites

1                    Candidates must be Accredited members of BABO and be entitled to appear on the BABO accreditation list to accept referrals from the public, having completed OVT 1, 2 and 3 or comparable courses. Conferment of BABO Fellowship requires independent learning and consolidation of the courses. Practitioners should have completed at least fifty patient cases.

2                    Candidates must have been registered as an optometrist with the GOC (or other National licensing body) for an equivalent of at least four years full time practice before applying for the examination and course.

3                    No candidate may be accepted without being a fully paid up member of the Association both at the time of the application and at the time of taking the examination and course.

4                    All candidates will be required to satisfy BABO that they have sufficient professional indemnity insurance and all National registration is current.

Regulation

1                    Before presenting themselves for the examination, the candidates must show that they have been registered with the GOC, and practised as an optometrist, for at least 4 years. Overseas candidates will be accepted subject to recognition by the education committee of BABO that their degree and registration is comparable to standards set in the UK .

2                    Candidates are expected to conduct themselves throughout the examination in a manner appropriate to a professional examination.

3                    The examination will be conducted in English at all times.

4                    Candidates must sign an application form for the examination, agreeing to abide by the rules and regulations.  The last date for application for the examinations will be announced but will not be less than four weeks prior to the examination date.  Late entries may be accepted at the discretion of BABO.  A late entry fee will then be payable.

5                    If candidates fail to present themselves at the examination, they are entitled to present themselves at a subsequent examination subject to payment of the appropriate fee and subject to complying with all other rules. In no cases will fees be returned.

6                    Candidates who fail to present themselves at the examination may only take the next examination without further fee in the case of illness AND where a valid medical certificate is received by BABO within seven working days of the examination.

7                    If candidates fail to present themselves at the examination without the support of a valid medical certificate, they will be deemed to have failed the examination.

8                    If candidates are late in any section of the examination, it is at the discretion of the BABO examination supervisor to cancel that examination.  Candidates will be deemed to have been absent and the rules in 6 and 7 will apply.

9                    For the purpose of these regulations, all sections of the examination must have been passed within a period of FOUR years from participation in the compulsory VT4 course. There are no limits to the number of times each section may be taken subject to the availability of examination sittings.

10                Candidates will be notified in writing of their success/failure of the examination by BABO within two weeks of the final assessment.

11                Passes in all sections of the examination are required within a four year period for the award of the diploma. All four open book questions must be passed before the candidate moves to further sections of the examination. Up to two individual sections (case records, multiple choice exam or viva) of the certification course may be re-taken at a re-sit examination day six months after the original examination day.  If more than two sections are failed, candidates will be required to re-sit the complete examination process on another occasion.  Candidates who fail any section of the examination process will be informed in writing of the dates and costs of re-examination, as determined by BABO. In the event that a candidate is unable to pass all sections of the examination within the period of four years, candidates will be required to take the complete examination cycle again.   Candidates who are unsuccessful at the second examination cycle (ie exam, re-sit, exam re-sit twice) will be refused entry to further cycles of the examination.

12                Where the candidate fails to complete all the requirements in the examination within the four year period, they will be required to re-take all sections of the course and examination again.

13                Candidates must submit their case records and open book questions for scrutiny and assessment by the due date or they will be deemed to have failed that section of the examination.

14                Any complaint about the conduct of the examination must be made immediately after the examination and before leaving the venue to the BABO examinations supervising officer. The supervising officer will take the appropriate action and advise whether the candidate should make their complaint in writing.  Should this be necessary, no complaint will be entertained if it is received after a period of 10 working days from the date of the examination.

15                Candidates who have failed any section of the examination may appeal to BABO.  The appeal must be made within 10 working days of notification of the examination result. For each individual result that an appeal is made, a fee will be charged according to the schedule of fees in force at the time of the appeal.

16                In all matters of dispute relating to the Certificate Course and Examination, the Education Sub Committee of BABO shall be the final arbiter.

17                At the specific written request of the candidate, the results may be sent to a third party.

18                Once formal notification of the success has been received, members shall be entitled to use the appropriate letters after their name in accordance with the rules made, from time to time, by BABO.

19                BABO reserves the right to withdraw the right to use the appropriate annotation at its discretion. Maintenance of Membership or Fellowship would be dependent upon maintaining regular CET, as now, and payment of the BABO membership fee.

Specification of the Certification

 The following specification of the certification was approved by BABO on the17th September 2007 for all examinations conducted after October 2007.

Sections  

A         Completion of strabismus and amblyopia course (3 days residential)

B         Completion of four open book questions 

C         Presentation of four case studies

D         MCQ examination

E          Viva examination

Section A

A three day Strabismus and Amblyopia course (OVT4) will be attended. This course comprises aspects of examination and treatment of strabismus and amblyopia therapy.   This course is intended as a foundation and may not cover every aspect of the subject in the specification.  The candidate must therefore satisfy him/herself that adequate preparation has been made and the relevant background reading and experience has been gained. The syllabus for VT4 is in Appendix 2.

Section B

Four open book questions must be submitted. Details of the submission dates and questions will be provided. The open book questions will be published and may be changed at any time at the discretion of BABO.  The example questions appear in Appendix 3. All four open book questions must be passed before the candidate moves to sections C, D and E.

Section C

The candidate will be required to present four case studies in order to demonstrate the breadth of practice and extended expertise. These case studies should be one each of the following:

           (i) evaluation and treatment of strabismus or amblyopia

(ii) a specific learning difficulties case

(iii) a lens case

     +    (iv) free choice of one other case which may include low vision rehabilitation or traumatic brain injury at the discretion of the candidate. 

BABO will consider a flexible approach to these subject headings in exceptional circumstances.  Such a circumstance might be where a candidate is not practising in the UK and the regulatory body in the country of practise prohibits treatment of certain areas.

It is envisaged that one case record will be forwarded to an examiner early in the preparation process in order for the candidate to be given feedback so that candidates can ensure they are attaining an appropriate standard before formally presenting their work.

Section D

MCQ examination, comprising 40 questions to be taken in 1 hour.

Section E

Viva – a one hour oral examination, with two examiners, covering any aspect of behavioural optometry, detailed discussions of the case studies, and may include a discussion of the open book answers.

Fellowship Higher Diploma

 In order to gain the use of Fellow of the Association Higher Diploma – FBABO(HD) candidates would need to take an approved Research Methodology and Statistics course at a local University (or appelle a course already taken), and present a research project that has been peer reviewed by the examiners or experienced reviewers appointed by BABO for the purpose, to a standard suitable for publication. The candidate will present the project to the examiners as part of a one hour viva, and recommendation for the award will be given to the BABO Education Sub Committee for approval. Successful candidates will be expected to present their work at a BABO study day or AGM.

Mentoring

Each candidate will be assigned a mentor to assist with the scientific approach, literature study, give guidance and encouragement, and advise generally.

 There is no time limit on Fellowship Higher Diploma.

Appendix 1

Accreditation and Certification process for BABO 2006  

Appendix 2   - OVT1, OVT2, OVT3 and OVT4 Specifications

OVT1 Introduction to Behavioural Optometry Specification 

BEHAVIOURAL OPTOMETRY
                  ·         Perception
                  ·         Optometric vision therapy
OPTOMETRIC VISION THERAPY
                  ·         Vision Therapy Procedures - underlying principles

·         Success in Vision Therapy

·         Visual Considerations

THE VISUAL PROBLEMS  - CHILDREN

·         How many under performing children are there?

·         Children with reduced academic performance

·         Ametropia

·         Children with referable visual problems (age 9-12)

·         Accommodative problems classification

·         Symptoms in accommodation disorders

TESTS FOR ACCOMMODATIVE PROBLEMS

·         Amplitude

·         Binocular Accommodative Facility

·         Positive and negative relative accommodation

·         MEM retinoscopy

TREATMENT OF ACCOMMODATIVE PROBLEMS

·         Correction of Ametropia

·         Methods

BINOCULAR FUSIONAL FUNCTION TESTING PROCEDURES

·         NPC

·         Phorias

·         AC:A

·         Gradient method

·         Fusional reserves

·         PRA/NRA

·         Binocular flippers

·         Stereopsis

TABLE OF EXPECTEDS:VERGENCE TESTING

·         Tests Evaluating Positive Fusional Vergence (PFV Group)

·         Tests Evaluating Negative Fusional Vergence (NFV Group)

·         Tests Evaluating the Accommodative System (ACC Group)

·         Tests Evaluating the Ocular Motor System

·         Tests Evaluating Vertical Fusional Vergence (VFV Group)

·         Motor Alignment and Interaction Tests (MAIT Group)

BINOCULAR ANOMALIES

·         Heterophoria with Low AC/A Ratio

·         Heterophoria with Normal AC/A Ratio

·         Heterophoria with High AC/A Ratio

·         Vertical Heterophoria

·         Accommodative Anomalies

·         Ocular Motor Problems

CLASSIFICATION OF THE VISION DISORDER

·         Binocular Vision, Accommodative And Ocular Motor Anomalies

·         Binocular Vision Disorders With A Low Ac/A Ratio

·         Orthophoria at Distance - Convergence Insufficiency

·         Exophoria at Distance - Convergence Insufficiency

·         Esophoria at Distance - Divergence Insufficiency

·         Orthophoria at Distance and Near- Fusional Vergence Dysfunction

·         Exophoria at Distance - Basic Exophoria

·         Esophoria at Distance - Basic Esophoria

·         Orthophoria at Distance - Convergence Excess

·         Esophoria at Distance - Convergence Excess

·         Exophoria at Distance - Divergence Excess

·         Accommodative Insufficiency

·         Ill-sustained Accommodation

·         Accommodative Excess

·         Accommodative Infacility (Inertia of Accommodation)

CLASSIFICATION OF OCULAR MOTOR ANOMALIES

TREATMENT APPROACH TO BINOCULAR VISION DYSFUNCTION

·         Correct ametropia

·         Lenses (for treatment)

·         Optometric vision therapy

·         Techniques

                          Brock string/dot card

                          Binocular  flippers +/-

                          Binocular flippers -bi/bo

                          Dino card

                          Vectograms

                          Stereoscopes

                          Aperture rules

NEAR POINT STRESS, NEAR POINT RETINOSCOPY AND PLUS LENSES

·         What is Near Point Stress?

·         Traditional models of near point stress

·         Less Traditional Models

·         Eustress and Distress

·         Skeffington’s 4 circles

CLINICAL RECOGNITION OF NEAR POINT STRESS

·         Symptoms

·         Failure to sustain at near

NEAR POINT RETINOSCOPY TECHNIQUES

·         MEM (Monocular Estimation Method)

·         Book Retinoscopy

·         Bell Retinoscopy

·         Stress Point Retinoscopy

·         Treatment of Near Point Stress

·         Why Plus Lenses Help

·         How and when to Prescribe Plus

·         How Can You Check The Results?

OCULOMOTOR DYSFUNCTION

·         Symptoms

·         Diagnostic Findings

·         KD Test

·         DEM

·         Maples Oculomotor Test

·         OMD treatment

·         Ocular Pursuit Training

Hart chart

Hart chart near/far focus

Trombone reading

Physiological Diplopia (Phys Dip)

Eye Control

See Three Coins

Brock String

Binocular Accommodative Rock

Dinosaur Fusion Transparency

Rotations

Clock Rotations at Near

OVT2 Nuts and Bolts Specification

WHAT IS OVT?

VISUAL PROBLEMS

·          Omission not commission

·          Unmet visual need

·          Patients may not be aware of the problem

THE NATURE OF VISION

·          Learn

·          Experience

·          Dominant

·          Affects posture

·          Constructed

·          Heavily influences perception

SKEFFINGTON CIRCLES REVISITED

·          Centring (Where is it?)

·          Identification (What is it?)

·          Anti Gravity (Where am I?)

·          Communication (What can I tell you about it?)

SENSORY INTEGRATION

·           Distance

·           Time

·           Space  

·           3 Triangles

·           Vision Hygiene

VISUAL STRESS REDUCTION

·            Lenses and Posture

·            Perceptual and cognitive aspects

·            Level 3 - Habituate

TRADITIONAL OEP TESTING -   21 Point test

1       Ophthalmoscopy     

2       Keratometry

3       Habitual lateral phoria at distance    0.5XOP

13a   Habitual lateral phoria at near     6 XOP

4      Distance retinoscopy

5      Near point retinoscopy at 20 inches

6      Retinoscopy at 40 inches

7      Basic Subjective formula

7a     Maximum plus to best acuity at distance

8      Induced lateral phoria at distance    0.5 XOP

9      Base out at distance to first blur    7-9

10    Base out to break and recovery    19/10 min

11    Base in to break and recovery at distance   9/5  min

12    Vertical phorias and ductions at distance    ortho and =

13b  Induced lateral phoria at near     6 XOP

14a        Unfused cross cylinder

14b   Fused crossed cylinder

15b   Lateral phoria through the fused crossed cylinder

16a        Base out to complete blur at near       15           

16b   Base out to break and recovery at near     21/15 min

17a        Base in to complete blur at near          14

17b   Base in to break and recovery at near      22/18 min

18     Vertical phorias at near           ortho

19     Amplitude of accommodation         5 min

20     Positive relative accommodation       -2.00 to -2.25

21     Negative relative accommodation         +1.75 to +2.00

Additional extras

22     Monocular Accommodative facility at near

23     Binocular accommodative facility at near

24     Colour vision - Ishihara

25     Motilities, fixations pursuits and grasp and reach  tests

26     Hand-eye, developmental and perceptual batteries

27     Howell AC:A

28     NPA in free space

What is wrong with the 21 point test?

ACCOMMODATIVE TESTING

·         The accommodation/Identification process

·         SILO/SOLI

BINOCULAR EVALUATION

·         Cover test

·         NPC

·         Phoria

·         Prism Vergences (fusional ranges)

·         Just Noticeable Differences  

·         Stereopsis

VISUAL PERCEPTUAL PERFORMANCE – to be covered in detail in OVT3

·         Motor Bilateral Integration

·         Balance

·         Laterality-Directionality

·         R-L Awareness test

·         Spatial relations Sub-test TVPS

·         Visual-Motor Integration

·         Beery Developmental Test of VMI 

·         Wold Visuo-Motor Test

·         Visual Perception- Non Motor

·         TVPS

·         Visual discrimination

·         Visual Form Constancy

·         Visual Figure Ground

·         Visual Closure

·         Information Span- Visual Memory and Visualisation