“If you can fix people’s binocular vision problems, you make them more comfortable and you make their quality of life better,” Dr Catherine Porter, senior lecturer at the University of Manchester, told delegates at the AOP’s Locum Clinical Skills Conference (October 8).
Porter explained that binocular vision issues “cause all sorts of problems,” ranging from headaches and avoidance of near work to disrupted education for children.
“It’s a big thing when you fix it,” she said, adding that addressing these issues is often “easy to do.”
She encouraged practitioners to approach binocular vision systematically. A simple step-by-step method – checking the prescription, performing a cover test, assessing how the patient focuses and how they converge – can lead to most of the answers needed.
“If optometrists do those four basic things well, that will support a lot of getting to the bottom of the issue,” she said. While additional tests may be required for a full diagnosis, these steps provide “a good idea of what’s going on.”
Porter presented a series of case studies to support locum delegates’ learning, including discussion on managing convergence issues.
She advised that when recommending exercises, “you want people to use two pens rather than just one,” explaining that two pens better support patients’ understanding of fusion.
Many symptoms associated with binocular vision – such as double vision, blurred vision, headaches, or words appearing to move – can suggest either a refractive need or a convergence problem, she noted.
“I’m just listening – what are they having difficulties with?” Porter said.
Reflecting on her own early career, Porter said that when she graduated the only available method for checking children’s vision involved letter matching.
What had not been recognised at the time, she shared, was that a child’s visual performance is influenced by surrounding detail, not just letter size. “It is much easier to read one single letter on its own than when something is squashed around it,” Porter said.
For children aged one to 12, she advised using 1% cyclopentolate. “Those children have so much focus and ability. If you use the weaker strength, you are not going to relax over-accommodation and you will not get the full prescription,” she explained.
“Relaxing their accommodation helps turn their eyes out and keep them straight,” she explained.
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