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In this blog we are going to discuss Binocular Vision Assessments, how they differ from annual comprehensive eye exams and what type of doctor performs Binocular Vision Assessments. Binocular Vision Assessments diagnose and establish a treatment plan for Binocular Vision Dysfunction (also referred to as Binocular Vision Disorders); while annual comprehensive eye exams diagnose and establish a treatment plan for myopia (near-sightedness), hyperopia (far-sightedness), astigmatism, presbyopia, and ocular disease.

Binocular Vision Dysfunction (also referred to as Binocular Vision Disorders) is more common than you may think. A clinical trial to determine the prevalence of Binocular Vision Dysfunction within the overall population found that a possible 56% (or 60 million men, women, and young adults) exhibit symptoms associated with Binocular Vision Dysfunction. In a study of individuals eighteen to thirty-eight years of age, 56.2% of those exhibited symptoms associated with Binocular Vision Dysfunction. Another study revealed that Binocular Vision Dysfunction is 9.7 times more prevalent than ocular disease in children six months to five years of age; 8.5 time more prevalent than ocular disease in children six to eighteen years of age.

While these Binocular Vision Dysfunction statistics are alarming by any standard of measure, it is important to note that there is no correlation between the high prevalence of Binocular Vision Dysfunction within the general population and the rate at which Binocular Vision Dysfunction is being diagnosed by primary care optometrists. You may be asking yourself “how is this possible?”. The answer may surprise you. Primary care optometrists do not test for Binocular Vision Dysfunction and are not formally trained to diagnose or treat Binocular Vision Dysfunction. It is not at all uncommon for an individual to experience Binocular Vision Dysfunction only to be told by their primary care optometrist that “everything is normal” or “there is not a problem with your vision, you see 20/20”. This leads to frustration among adult patients and, in the case of children, parents wondering why the struggles in school and why the behavior problems.

Let's look at the definition of Binocular Vision Dysfunction: It is the inability to maintain visual focus on an object with both eyes, to create one single image. With a properly functioning binocular vision system, the two separate images from the two eyes are combined into one image in the brain. For individuals suffering from Binocular Vision Dysfunction, the two separate images from the two eyes cannot be successfully merged into one image in the brain. This results in:

• Abnormal adaptations to posture, or position

• Abnormal fatigue

• Avoidance of reading or near task work

• Blurred vision (near vision or distance vision)

• Closing or covering one eye while working on the computer or reading

• Clumsiness or lack of coordination

• Difficulty sustaining near focus, near visual function

• Dizziness

• Double vision

• Eye strain – often related to prolonged, visually demanding near centered tasks such as computer use or reading

• Fatigue while reading

• Headaches

• Images that appear to move in the peripheral vision, when they aren't really moving

• Light-headedness

• Motion sickness, car sickness

• Moving the head side to side while reading

• Nausea

• Photophobia – light sensitivity

• Poor depth perception

• Re-reading text for comprehension

• Shadowed vision (letters or words appear shadowed, or shaded)

• Skipping lines, or losing place while reading

• Using a finger as a guide when reading

• Vestibular issues (problems with balance)

• Walking into door frames, edges of table, corners of counters and furniture

• Words running together while reading

It is important to note that individuals who suffer from Binocular Vision Dysfunction may experience all or only a few of the symptoms listed above, which makes Binocular Vision Dysfunction difficult to diagnose – especially by eye doctors who have not completed a Residency Program that includes training specific to the diagnosis and treatment of Binocular Vision Dysfunction.

Only optometrists who have completed a formal Residency Program in Neuro-Optometry or Binocular Vision are qualified to diagnose and treat Binocular Vision Dysfunction. Ryan C. Johnson OD, FAAO is a binocular vision specialist. Dr. Johnson completed his Neuro-Optometry Residency at the University of California Berkeley following graduation from Southern California College of Optometry. Dr. Johnson sees both pediatric and adult patients, and no referral is necessary to schedule an appointment. He is accepting new patients and is in-network with most insurances.

How is a Binocular Vision Assessment different from a comprehensive, annual eye exam?

During a comprehensive, annual eye examination the eye doctor:

• Evaluates ocular health and the advancement of any ocular disease

• Tests distance vision – visual acuity (using a standard eye chart)

• Tests near vision – visual acuity (using a reading card)

During a Binocular Vision Assessment, the eye doctor evaluates both binocular vision functioning and visual perceptual skills:

• Accommodation

• Convergence

• Depth perception (3D)

• Fusion

• Ocular motility

• Ocular posture

• Presence of conditions that affect binocular vision functioning

• Spatial awareness / planning

• Stereopsis

• Tracking

• Vergence

• Visual acuity

• Visual-motor integration

• Visual perception

• Visual processing speed

• Working memory

Perhaps you, or your child, have already had an annual eye exam with a primary care eye doctor; been told everything is normal, and are experiencing symptoms of Binocular Vision Dysfunction. Medical insurance policies typically include Binocular Vision Dysfunction as a policy benefit. This means that even though you may have exhausted your vision insurance benefit, a Binocular Vision Assessment would be considered a medical insurance benefit. There's no need to struggle with Binocular Vision Dysfunction, help is one phone call away. Give our office a call at (208) 377.8899.