Binocular vision assessment is important before refractive surgery Appropriate refractive corrective and binocular balancing are nonetheless the foundational aspects before venturing into a BV testing. The comprehensive test battery for BV assessment should include testing for near point of convergence, near point of accommodation, relative accommodation, accommodation response and facility, vergence amplitudes and facility, distance and near phoria, and the Accommodation convergence to accommodation (AC/A) ratio (13). A comprehensive evaluation of binocular visionĪ comprehensive evaluation of binocular vision should include testing for accommodation, and vergence parameters in addition to tracking and reading eye movement parameters wherever applicable. Children with Autism and learning disabilities also require careful evaluation of binocular vision so that remediation of these dysfunctions can potentially impact the vision-related quality of life of this special population (11, 12). Children with Down syndrome are shown to have reduced accommodation capabilities for their age requiring the need to provide appropriate refractive correction (9, 10). Nonetheless, it is imperative to understand that children with special needs are at an increased risk of binocular vision dysfunctions. This makes specialized testing such as a binocular vision assessment more complicated. Binocular vision anomalies are common among children with special needsĬhildren with special needs are often considered a challenge during an eye examination due to the reduced accuracy of subjective responses and the need for skilled professionals. Binocular vision assessment is also indicated in Anisometropia, Keratoconus (4,5), amblyopia (6), and Myopia (7,8). So, when a patient complains of asthenopic symptoms unexplained by a regular eye examination, a comprehensive binocular vision assessment is warranted even in the absence of significant refractive errors (2). The efficiency of the visual system is not just dependent on the integrity of the visual apparatus, and monocular visual acuities, but also on a well-functioning and integrated binocular vision (BV).
Many eye care practitioners unfortunately still assume that 20/20 visual acuity ensures an optimally functioning visual system.
The efficiency of the visual system is beyond 20/20 This article specifically focuses on non-strabismic binocular vision anomalies as they are often missed out due to their latent nature, unlike strabismic anomalies. Here are some pearls to ensure accurate diagnosis and provide appropriate management to patients afflicted with binocular vision anomalies. It is also shown in a recent study that clinically significant convergence insufficiency can impair stereo-acuity in children necessitating the diagnosis and management of convergence insufficiency (3).
The prevalence reports from various parts of the globe quote a high prevalence ranging between 28.5-31.5% among school children (1,2). The prevalence of non-strabismic binocular vision anomalies is on the rise over the last decade.
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