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Optometry plays an important role in both diagnosing and managing binocular vision disorders. Binocular vision disorders have been associated with increased near-work symptoms1 and reduced academic achievement,2 while successful treatment of a binocular vision disorder has been associated with reduced adverse academic behaviours and reduced parental concern regarding academic achievement.3 A binocular vision assessment is therefore an important component of a routine optometric consultation.
Additionally, practitioners also need to know the effect a patient’s binocular vision status has on myopia-management. Deficiencies in various binocular vision functions have been associated with myopia progression. The various myopia-management strategies may also affect binocular vision, which may or may not be beneficial depending on the individual’s binocular vision status. For example, centre-distance multifocal soft contact lenses increase near exophoria,4 and while this may be beneficial for eso-related or accommodative insufficiency-related disorders, it is less beneficial for exo-related or accommodative excess-related disorders. It is therefore incumbent on the practitioner performing myopia-management to be aware of a patient’s binocular vision status and manage a patient’s binocular vision disorder. Management of a binocular vision disorder may involve choosing myopia-management strategies that are beneficial to a patient’s binocular vision status, performing vision therapy or referring to another practitioner specialising in vision therapy.
The International Myopia Institute5 (IMI) recommends the following tests be performed at a baseline examination and at follow-up visits to monitor changes with myopia-management strategies:
The IMI also lists various clinical methods that can be used to measure these outcomes.5
In addition to these tests, the practitioner may also consider tests at baseline that aid in differential diagnosis of a binocular vision disorder. These include monocular accommodative facility, near point of convergence, negative and positive fusional reserves at distance and near and negative and positive relative accommodation (B+ and B-, respectively) at near.6
Much of the interest in binocular vision and myopia-management stems from differences in myopes compared to non-myopes for various aspects of binocular function, particularly accommodative function. Myopes tend to have a higher lag of accommodation and a lower amplitude of accommodation. This need for the myope to increase accommodative effort at near is a a contributing factor to other differences in binocular vision function, such as tendency towards esophoria and increased gradient AC/A ratio.
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