Binocular Vision: Why is it So Important?
Department of Optometry, Rand Afrikaans University (RAU), Founder at Eyeli, South Africa
*Corresponding Author: Ilse Homan, Department of Optometry, Rand Afrikaans University (RAU), Founder at Eyeli, South Africa.
Received: April 25, 2021; Published: May 19, 2021
Binocular vision should form a fundamental part of every visual assessment, especially when looking after children’s vision, for three main reasons.
Comfortable vision when reading and learning:
- Having two eyes that work together, enables us to have three-dimensional vision, depth perception, distance judgement and eye-hand coordination. Without binocular vision, catching a ball, driving a car or even a simple task like walking becomes difficult.
- Binocular vision problems could have a significant effect on quality of life and have the best prognosis if diagnosed and treated early when the visual system is still developing .
Myopia onset, progression and management:
- Children spent at least 60% of their time in the classroom looking at near objects and digital screens, with fixations from distance-to-near occurring 10 times a minute. This requires a sable and accurate visual system to ensure comfort and comprehension .
- An insufficient accommodation reserve affects our ability to focus on near work for sustained periods, while accommodation infacility would make changing focus form distance-to-near slow and tedious.
- Alignment issues, like reduced vergence facility and esophoria, are known to affect not only our visual comfort, but also speed and accuracy during reading .
- Convergence insufficiency (CI) becomes so uncomfortable, that it is linked to behaviours issues like attention and avoidance of schoolwork. Many children have been diagnosed with attention deficit hyperactivity disorder (ADHD), when in fact, they actually had CI .
- Myopia is affected by inaccurate binocular vision - including near esophoria, higher AC/A ratios, accommodative lag and greater variability in accommodative responses [5-8].
- Intermittent exotropia (IXT) has also been associated with a higher prevalence of myopia, with 47% of children with IXT becoming myopic by age 10 and 91% by age 20 .
- Binocular vision is therefore a very important consideration when deciding on treatment options for a myopic patient.
- Myopia management, when esophoria, accommodation issues and higher AC/A ratios are present, have shown better efficacy with progressive addition or bifocal (BF) spectacle lenses, as supposed to peripheral defocus spectacle or contact lenses .
- Fitting exo myopic children from spectacles to contact lenses, can increase their exo deviation which could affect visual comfort and myopia control efficacy [11,12].
- Marianne EF and Simmers AJ. “‘It’s too late’. Is it really? Considerations for amblyopia treatment in older children”. Therapeutic Advances in Ophthalmology 11 (2019): 2515841419857379.
- Narayanasamy S. “Visual demands in modern Australian primary school classrooms”. Clinical and Experimental Optometry 3 (2016): 233-240.
- Quaid P and Simpson T. “Association between reading speed, cycloplegic refractive error, and oculomotor function in reading disabled children versus controls”. Graefe's Archive for Clinical and Experimental Ophthalmology 1 (2013): 169-187.
- Granet DB., et al. “The relationship between convergence insufficiency and ADHD”. Strabismus 4 (2005): 163-168.
- Ciuffreda KJ and Vasudevan B. “Nearwork-induced transient myopia (NITM) and Permanent myopia – is there a link?” Ophthalmic and Physiological Optics 2 (2008): 103-114.
- Seidemann A and Schaeffel F. “An evaluation of the lag of accommodation using photorefraction”. Vision Research 4 (2003): 419-430.
- Chung KM and Chong E. “Near esoporia is associated with high myopia”. Clinical and Experimental Optometry 2 (2000): 71-75.
- Gwiazda J., et al. “Response AC/A ratios are elevated in myopic children”. Ophthalmic and Physiological Optics 2 (2002): 173-179.
- Ekdawi NS., et al. “The Development of Myopia Among Children with Intermittent Exotropia”. American Journal of Ophthalmology 3 (2010): 503-507.
- Fulk GW., et al. “A Randomized Trail of the Effect of Single-Vision vs. Bifocal Lenses on Myopia Progression in Children with Esophoria”. Optometry and Vision Science 8 (2000): 395-401.
- Gwiazda J., et al. “A randomized clinical trial of progressive addition lenses versus single vision lenses on the progression of myopia in children”. Investigative Ophthalmology and Visual Science 4 (2003): 1492-1500.
- Hunt OA., et al. “Ocular motor triad with single vision contact lenses compared to spectacle lenses”. Contact Lens and Anterior Eye 5 (2006): 239-245.