Binocular Vision

Who Should Have a Binocular Vision Assessment?

A Binocular Vision Assessment is designed for both children and adults.

CHILDREN

A Binocular Vision Assessment is recommended for children who struggle with visual tasks or who are symptomatic. The types of vision conditions identified during a Binocular Vision Assessment can affect both academic and athletic performance. It is estimated that 1 in 4 children have a vision problem significant enough to affect academic performance. This occurs because the child has difficulties efficiently taking in and interpreting visual information. In the classroom, vision conditions commonly affect reading, computer or other screen-time activities, and taking notes from the board. These tasks are extremely visually-demanding and require efficient eye tracking, eye teaming and eye focusing.

Symptoms of these vision conditions vary greatly. An underlying vision problem should be suspected by the parents and teacher if a child complains of:

• Blurred or fluctuating vision
• Double vision (even intermittent)
• Eye strain, discomfort or soreness
• Headaches after visual tasks
• Visual fatigue
• Words moving or floating on the page

Not all children voice complaints about their visual performance (many think how they see is 'normal'). Parents and teachers should look for the signs of an underlying vision problem:

• Abnormal posture during near tasks (tilting or turning the head, leaning very close to the page, constant moving and re-positioning while working)
• Avoidance of visual tasks, such as reading (would rather be 'read to' or refuses to read)
• Covering or closing one eye (especially while reading)
• Difficulties completing visual tasks (reading, taking notes, etc) in the time allowed
• Drastic improvement with verbal tasks as compared to visual tasks
• Frequent blinking
• Skipping or re-reading words or lines of text
• Squinting
• Use of a finger (or line guide) to keep place while reading

ADULTS

Children do not grow out of the types of vision conditions identified during a Binocular Vision Assessment. As adults, they continue to experience the same symptoms as they did as children (blurred or fluctuating vision, double vision, eye strain or headaches). Many have found ways to compensate for their visual conditions; often by avoiding or limiting visual tasks. Others have accepted their visual limitations as 'normal for them'.

A Binocular Vision Assessment should be performed for adults with symptoms such as:

• Blurred or fluctuating vision despite correction with glasses or contacts
• Difficulties with 3D movies or TV (poor depth perception, discomfort, nausea)
• Double vision (even intermittent)
• Eye strain or discomfort with visual tasks (such as reading or computer work)
• Headaches following reading, computer work or time on electronic devices
• Visual fatigue
   

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What is Tested During a Binocular Vision Assessment?

Our team evaluates several aspects of visual function during a Binocular Vision Assessment using age-normed, standardized testing. Based on the results, our doctors will prescribe an individualized treatment plan. Skills tested include:

Accommodation (Eye Focusing)

While seeing clearly is important, it is equally important to keep things clear. Accommodation, or eye focusing, allows an athlete to keep the game in focus. The strength, speed and accuracy of accommodation are especially important when viewing objects moving at high speeds (such as a ball or puck) or when scanning the field of play.

Depth Perception (3D)

Often called “3D vision”, depth perception is dependent on the ability to use both eyes together in a very precise manner. Depth perception is important in every sport. Precise depth perception allows you to identify the exact location of an object (for example a ball) so that you can hit, kick or catch it. Depth perception also tells that athlete where they are in space, which is especially important when in motion.

Fusion

Fusion is the ability to use both eyes together - is the foundation of depth perception and binocular vision (utilizing both eyes in a coordinated manner). Stable fusion allows the athlete to take in visual information in a reliable and consistent way. Instability of fusion disrupts athletic performance and can lead to inconsistent performance or difficulties with specific aspects of your game.

Presence of Conditions That Affect Binocular Vision Function

There are several conditions that affect binocular vision function. Some of these conditions are ocular (such as amblyopia, strabismus, cataracts, glaucoma, and several other ocular diseases) while others are systemic (such as diabetes, stroke, thyroid dysfunction, autism, and cerebral palsy to name a few). Our doctors work with your other health care providers to ensure a multi-disciplinary team approach to your overall care.

Ocular Motility (Eye Movements)

Eye movements must be fast, accurate, and coordinated while participating in sports. Eye movements are used to quickly scan the field of play or to track a moving object. The saying 'keep your eye on the ball' stresses the importance of efficient eye movements during competition.

Ocular Posture (Resting Position)

Ocular posture, or the resting position of the two eyes, is evaluated to determine the presence or absence of strabismus (eye turn). Eye position is also related to how hard you must work to coordinate your eyes. Depth perception, fusion, ocular motility, vergence, and visual acuity are all affected by ocular posture.

Vergence (Eye Teaming)

The strength and flexibility of the eye teaming system should be evaluated. Deficits in eye teaming will result in double vision, eyestrain, fatigue, headaches, or dizziness. Deficiencies of the vergence system will affect sports performance either globally or during specific aspects of your game (such as putting in golf).

Visual Acuity (Clarity)

Clear vision is the foundation of both visual performance and overall performance. Simply put, if you cannot see well you cannot expect to play well. While 20/20 vision is adequate for daily life, most competitive athletes benefit from seeing better than 20/20. Athletes rely on clear vision to perform at their best.

Processing Speed

Once visual information is taken in, it must be processed by the brain. Visual processing speed refers to how quickly and efficiently an athlete is able to make sense of visual information. In other words, how much information can an athlete process in a given amount of time. Processing speed allows for split second decisions and reactions to a changing visual environment.

Spatial Awareness/Visual Attention

People often comment that an athlete has 'vision' or 'sees the game'.They are referring to the player's spatial awareness and visual attention. Sports often require an athlete to divide their visual attention between central objects (such as the ball) and peripheral objects (such as incoming defenders). Seeing the game allows an athlete to play at a high level.

Visual Integration

The integration of visual information with the other senses is critical. Making sense of your world relies on all of the senses working harmoniously. The integration of visual and motor skills is important during athletic competition. People often refer to this skill as 'hand-eye coordination'.

Visual Perception

This group of skills includes visual discrimination (determining likeness), spatial relations (determining differences), form constancy (determining sameness even when changed in size or orientation), visual memory, visual sequential memory, figure-ground (extracting valuable information from the background), and visual closure (ability to put the pieces together to form the whole). These perceptual skills are essential for athletic success.

Working Memory

This perceptual skill is critical for the acquisition of new material and concepts. Deficits in working memory can result in challenges learning new concepts; such as spelling. Those who struggle with working memory often find that no matter how hard (or how long) they try, the desired results are not achieved.

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Frequently Asked Questions About Binocular Vision Assessments

Are vision problems and behavioral problems related?

According to a recent survey, 39% of parents don't realize that behavioral problems can be an indication that a child has a vision problem. A child with undetected vision problems may get frustrated or bored in school because he or she can't see the board, the teacher or read a book easily. Therefore, students with problems seeing sometimes act out. Studies indicate that 60% of children identified as having a learning problem actually suffer from undetected vision problems.

My child dislikes reading, could this be a vision problem?

Children with convergence insufficiency will start out satisfactorily, but after a short period of working up close will find it difficult to continue reading due to the amount of difficulty with their vision. Their tendency to look away will make them appear to be disinterested, or have a poor attention span. These same children will appear more interested when they are being read to, or listening. They will then be labeled “attention deficit” or “lazy” when they are simply limited based on their visual abilities.

Why do I see double?

There are several causes of double vision and it is very important to determine the underlying cause. Double vision can present in may different ways and the pattern of double vision (where the two images are relative to one another, how often the double vision is present, where the double vision is present, etc) will help our doctors determine the underlying cause.

Causes of double vision include:

• Convergence insufficiency
• Cranial nerve palsy (due to trauma, ischemia, aneurysm, brain tumor, or other neurological event)
• Damage to the cornea (infection, scarring, etc)
• Dry eye
• Extraocular muscle entrapment (occurring after trauma)
• Lens problems (such as cataracts)
• Loss of fusion due to ocular disease process (such as glaucoma, macular degeneration, etc)
• Strabismus (eye turn)
• Stroke
• Systemic conditions (Myasthenia gravis, Grave's disease, multiple sclerosis, Lyme disease, diabetes, etc)

Please note, if you see double at any time you should be evaluated by a doctor with advanced training (such as a residency) in binocular vision and neuro-optometry.

Will I know if I have binocular vision dysfunction?

Unfortunately not all individuals with binocular vision dysfunction are symptomatic. When symptoms do occur they include:

• Blurry vision
• Dizziness
• Double vision
• Eyestrain
• Fatigue (especially with near work)
• Headaches
• Impaired sports performance
• Lack of depth perception
• Light sensitivity
• Motion sickness (car sick)
• Nystagmus (jumping eyes)
• Reading difficulties

When someone with binocular vision dysfunction becomes symptomatic, adaptations usually begin to occur.

• If a child struggles with reading due to binocular vision dysfunction they may begin to use their finger or line guide for support, turn their head while reading, cover one eye while reading, prefer enlarged print (or e-reader), or avoid reading all together.
• If someone sees double they will often close or cover one eye, tilt or turn the head, or avoid the task or position that makes them see double.
• If the brain perceives double, it is capable of “shutting off” or suppressing the input from one of the eyes to eliminate the double vision. Suppression will eliminate the double vision, but prevents binocular vision functioning and stereopsis (3D vision).
• Lastly, some people just assume that the binocular vision dysfunction is “normal” and get used to eyestrain at the computer, headaches at 3D movies, and even double vision. If you suspect that you or your child has an undiagnosed vision problem, the next step is to schedule a binocular vision assessment with Advanced Vision Therapy Center.

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