Align your team on binocular vision disorders

Binocular vision dysfunctions can significantly affect patients’ quality of life, often negatively affecting work and scholastic performance, but clinical management of such diverse anomalies can be attainable—should doctors be up to the challenge.

A diverse group of visual anomalies, binocular vision dysfunction and impairment often doesn’t neatly fit into a specific diagnostic category as patients may present with defects in more than one area of binocular vision. Moreover, such impairments may affect patients of all ages and demographics and can occur due to developmental insufficiency or neurologic impairment and trauma, says Jacqueline Theis, O.D., AOA Vision Rehabilitation Committee member.

“Binocular vision impairments impact quality of life and can make patient participation in tasks of daily living impossible,” Dr. Theis says. “By evaluating how the eyes work together and ensuring system stability, you empower your patient to live the life they desire and visually participate without hesitation, reservation or symptom provocation.”

Adds Joshua Watt, O.D., AOA Sports & Performance Vision Committee chair: “If doctors and paraoptometrics can understand the true effect of binocular vision issues in the lives of their patients, they will understand that asking a few more questions or spending a minute more can make all the difference.”

Toward that end, an #AskAOA webinar hosted on the AOA EyeLearn Professional Development Hub will help doctors and their care teams meet the needs of these challenging patients. Presented by Drs. Theis and Watt, and supported by RightEye, the webinar offers expert advice and best practices regarding binocular vision dysfunctions.

Dr. Theis notes the course is intended for all doctors of optometry; not everyone needs to be a specialist or treating provider, but everyone needs to be able to assess and diagnose binocular vision to refer when appropriate.

“I think of checking the binocular vision system like checking [intraocular pressure]—it needs to be done on everyone as it is a biomarker of neurologic function,” Dr. Theis says. “Optometry has the ability to diagnose many neurologic impairments in the early onset stage, but to do so we need to have baselines to measure for change and to repeat testing periodically.

“Binocular vision impairments are best treated by optometrists because these are often non-surgical problems that drastically impede visual performance,” she adds. “There is no better profession capable of diagnosing and treating these patients.”

As noted in the AOA’s Brain Injury Electronic Resource Manual (BIERM), Vol. 1, optometry has become more involved in the management of vision problems associated with traumatic brain injury, even within the past decade, and management of binocular vision dysfunctions remains a significant component of this. In fact, “binocular vision deficits have been reported to be among the most common vision problems…after acquired brain injury,” the BIERM notes, with convergence insufficiency, exotropia and vertical deviation frequently reported.

So, what can participants expect from the #AskAOA webinar on binocular vision impairments? Drs. Theis and Watt share some topics of discussion in the peer-to-peer guidance, including:

• Importance of binocular vision assessment in children and adults.
• How to incorporate such evaluations into a primary care setting.
• The role of ancillary technology, as well as the pros/cons of incorporating technology.
• How paraoptometrics and symptom surveys can help determine testing or follow-up questions.
• Importance of neuroplasticity, even in adults, and recommended treatments.

“As doctors, we are taught these tests to perform and the reason behind the test in school,” Dr. Watt says. “Unfortunately, in an abbreviated exam slot not every applicable or screening test can be performed, and this could result in a patient ‘flying under the radar;’ they may not complain of symptoms but still be struggling. A peer-to-peer conversation will hopefully re-energize doctors on the importance of these tests and help them understand successful treatment options.”

Interested in information about vision rehabilitation or sports and performance vision? Visit these specialty sections on the AOA website for further tools and resources, as well as learn how to become involved in these specialties’ advocacy networks.