Introducing Martin Diep (MOptom BOptom BSc FACBO) from See Optometry, Victor Harbor SA. He has a special interest in Behavioural Optometry and is doing some amazing things in the world of Vision Therapy and Binocular Vision. Read ahead to find out more!
Tell us a little bit about yourself and how you got into Behavioural Optometry
Born and raised in Sydney, I studied Optometry at UNSW and graduated in 2014. My first gig was in regional South Australia in Port Augusta, a small town of 14,000 people 300km north of Adelaide, where I worked for 4 years before moving to my current practice in Victor Harbor, 80km south of Adelaide. It only took me a few months after graduating when I realised that my undergraduate degree only taught me the bare basics needed to survive the world of optometry, and I needed to upskill myself to actually know what I was doing, especially with patients with visual symptoms but no clinically significant visual findings. Hence I started my journey into the world of behavioural optometry; getting my Masters degree through UNSW in 2017 and my Fellowship with the Australiasian College of Behavioural Optometry (ACBO) in 2019.
-Tell us about your typical day or week at work
Optometry in my practice probably looks a bit different from a regular city optometry practice. On top of all the regular optometric clients, I also do a fair few paediatric consultations that have been referred by other optometrists and educators for learning related vision problems. These include a full binocular vision check as well as a developmental information visual processing check where I investigate problems with reading eye movements, visual spatial dysfunction, issues with visual analysis and visual memory, as well as visual-motor and visual-auditory integration skills. Throughout my week, I also do in-office vision therapy with my clients for a wide range of visual dysfunctions, from convergence insufficiency, to learning related visual dysfunctions and post traumatic vision syndrome following concussions and strokes.
How did you get into this unique area of optometry?
It took me about three months after graduating when I realised that there were a lot of patients where I could not explain the symptoms they were getting from the tests that I got taught at university and so I started trying to find some answers. I knew there was a gap in my knowledge (which were not a result of falling asleep in many lectures at uni!) I discovered that ACBO offered many postgraduate courses that covered the topics that I was least confident about and decided to go to the Art & Science course offered by the Optometric Extension Program. That was when my I realised that there was SO much that optometrists could offer clients that was not even mentioned during undergraduate study! As I learnt, I discovered how optometry is really the only profession that has the functional vision science knowledge to provide services for vision development, enhancement and rehabilitation and this opened up my world to the optometric management of developmental delays, autism, brain injury, sports vision and other visual issues that conventional optometry has no way of treating.
How do you keep up with the optometry world?
Postgraduate courses are the crux of my professional development. I go to more postgraduate courses than that needed to meet my minimum CPD requirements; at one stage I racked up 350-odd CPD points in one registration period! Keeping up with colleagues in the industry is also a great way of keeping in touch with what is happening in optics and it gives me great ideas on how to implement changes to my practice to enhance the patient experience.
Do you have any goals for your optometry career?
In Australia, the delivery of vision services to brain injury clients is abysmal. Even a basic visual acuity check, refraction and gross assessment of binocular vision is severely under-valued in hospitals and rehabilitation centres around the country. It is one of my goals to increase general awareness of the huge impact brain injury can have on the visual system and that optometrists can fix a lot of these problems with a simple pair of glasses.
I would also love the general optometric community to begin to understand that the unique tools that we have access to - lenses, prisms, tints, filters - can be used in more than one way. I want to encourage other optometrists to think outside the box; think about the person as a whole and how can you use what you have in front of you to change their lives for the better? For example, using based down yoked prisms in a CNIV paresis to eliminate diplopia on downgaze when reading. Sometimes the solution is easier than you think!
What keeps you sane outside of your work life? Do you have any hobbies or passions you pursue?
My hobbies are what keep me sane enough to to work in a high pressure environment with clients with complex needs. I work out regularly, 5 days a week at the gym and run a few times a week. I would like to think this is to keep fit, but in reality it’s to offset my love of baking for friends and family (and myself)!
What advice would you give to other optometrists who also wish to pursue this area of practice?
To be successful in behavioural optometry, you must approach it with an open mind, and be ready to learn and learn and learn. Once you start, you only then begin to realise how much you don’t know about the very job you’ve been trained to do and have been doing for the last however many years. ACBO is the best resource for optometrists looking to further their knowledge on binocular vision, learning related vision problems, and higher level topics like brain injury and sports vision. They have material of all levels that can meet your needs regardless of how in-depth your knowledge is in the area. Colleagues that have been practicing behavioural optometry for decades still benefit hugely from the ongoing CPD they provide.
It's easy to get stuck in the bubble of Optometry. What's something that you wish people knew about behavioural optometry?
Optometry is not just about subjective distance refraction and eye health. Don’t get me wrong; they are hugely important and they are the basic things all optometrists must test, but there is a whole other level of fundamental visual functions that a lot of optometrists do not even consider. For example, when was the last time you thought about fixation, let alone test for it? How do you even test for it? When you really think about it, what are the basic visual skills a person must have to even read your logMAR visual acuity chart? A few come to mind with examples:
● Accurate fixation and saccadic movements - to even know where to look let alone read across the line without skipping letters or confusing lines
● Accommodation - think of the psuedomyope with poor control of accommodation in the distance
● Vergence control - divergence excess strabismus have poor vergence control in the distance
● Visual spatial skills - how do you distinguish between an S and Z when they are fundamentally the same squiggle, just mirrored?
● Visual discrimination - how do you differentiate between a Y and V when one just looks like a longer version of the other?
● Visual figure-ground & central-peripheral control - How do non-amblyopes isolate the letter they are fixating on without getting distracted by all the other letters around them?
● A proper understanding between spatial concepts like text with temporal concepts like speech - How do they know that the visual representation of “A” is the same concept as the sound it makes?
How do you think a child with these vision problems would do at school with reading comprehension and spelling? They may see 6/6 and refract plano but there is so much more at play here and you as the optometrist can be the one who changes their lives.