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Topical Review: Assessment of Binocular Sensory Processes in Low Vision.

ABSTRACT:

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This article summarizes the evidence for a higher prevalence of binocular vision dysfunctions in individuals with vision impairment. Assessment for and identification of binocular vision dysfunctions can detect individuals experiencing difficulties in activities including reading, object placement tasks, and mobility.Comprehensive vision assessment in low vision populations is necessary to identify the extent of remaining vision and to enable directed rehabilitation efforts. In patients with vision impairment, little attention is typically paid to assessments of binocular vision, including ocular vergence, stereopsis, and binocular summation characteristics. In addition, binocular measurements of threshold automated visual fields are not routinely performed in clinical practice, leading to an incomplete understanding of individuals' binocular visual field and may affect rehabilitation outcomes.First, this review summarizes the prevalence of dysfunctions in ocular vergence, stereopsis, and binocular summation characteristics across a variety of ocular pathologies causing vision impairment. Second, this review examines the links between clinical measurements of binocular visual functions and outcome measures including quality of life and performance in functional tasks. There is an increased prevalence of dysfunctions in ocular alignment, stereopsis, and binocular summation across low vision cohorts compared with those with normal vision. The identification of binocular vision dysfunctions during routine low vision assessments is especially important in patients experiencing difficulties in activities of daily living, including but not limited to reading, object placement tasks, and mobility. However, further research is required to determine whether addressing the identified deficits in binocular vision in low vision rehabilitative efforts directly impacts patient outcomes.

SUBMITTER: Tong J

PROVIDER: S-EPMC8051935 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:SignificanceWe assessed the number of referrals for low vision (LV) services to determine if establishing an LV program at a large academic medical center impacted referral rates. Visual acuity (VA), referral outcome, location, and specialty were examined as factors that could impact referrals.PurposeThis study aimed to identify gaps in the referral process to LV services.MethodsElectronic medical records of patients were reviewed to ascertain the referral rate among those who qualified for services, both before (2014 to 2016) and after (2017 to 2019) the establishment of an LV program. The medical records were further subdivided into two categories based on VA in the better-seeing eye: 20/70 to 20/200 and 20/200 to worse vision.ResultsA total of 2014 patient records with VA qualifying for LV services were reviewed. The proportion of patients who had a VA of 20/70 to 20/200 inclusive in their better eye was 91.7%. A majority (89.8%) of patients with VA of 20/70 to 20/200 and 74.4% of patients with VA worse than 20/200 were never referred. Before establishing an LV program, only 2.2% of patients with VA of 20/70 to 20/200 were referred for services on their first visit, which improved to 8% after the program was established (odds ratio [OR], 3.88; 95% confidence interval [CI], 2.37 to 6.33; P < .001). Also, before the program's establishment, 12.5% of patients with VA worse than 20/200 were referred on their first visit, which increased to 31.9% after the program's establishment (OR, 3.29; 95% CI, 1.50 to 7.19; P = .002). Patients with VA worse than 20/200 were more likely to be referred (before: OR, 6.34 [95% CI, 3.03 to 13.28; P < .001]; after: OR, 5.38 [95% CI, 3.09 to 9.37; P < .001]). Our data also showed that 10.3% of patients in this study declined referral to LV services.ConclusionsReferral rates to LV services are low among patients who qualify. The establishment of an LV program at the medical center significantly increased referral rates. However, more improvement is necessary to connect patients to LV services.

Project description:SignificanceWith reported population differences in parameters of nonstrabismic binocular vision, the present study investigated and reports normative data among a sample of African children.PurposeThis study aimed to determine expected binocular visual function data among schoolchildren in the Central Region of Ghana.MethodsThe study used a prospective cross-sectional design and used a multistage cluster sampling approach. Eligible normal participants selected through the administration of Convergence Insufficiency Symptom Survey questionnaire (score <16) and preliminary vision screening underwent comprehensive binocular vision testing. Only data for participants who expressed no difficulty with the specific procedures were analyzed.ResultsA total of 1261 normal participants (11 to 17 years [mean, 14.75 ± 1.530 years]) were selected for comprehensive binocular vision testing in the normative data study. The means with ±1 standard deviation for normative data for the nonstrabismic binocular vision parameters include the following: accommodative target near point of convergence (NPC) break (6.10 ± 1.67 cm), NPC recovery (8.17 ± 1.67 cm), fixation light with red-green anaglyph (RG NPC) break (8.51 ± 2.43 cm), RG NPC recovery (10.95 ± 2.60 cm), cover test distance phoria (0.12 ± 0.79 exophoria), cover test near phoria (2.1 ± 2.3 exophoria), modified Thorington test near phoria (1.9 ± 2.5 exophoria), negative relative accommodation (+2.54 ± 0.75 D), positive relative accommodation (-2.58 ± 0.81 D), and the accommodative convergence over accommodation ratio (2.80 ± 1.07:1). Age (in years)-predicted normal linear regression equations for NPC break (5.13 + 0.07 × age), RG NPC break (10.00 - 0.10 × age), RG NPC recovery (12.83 - 0.13 × age), positive relative accommodation (2.05 + 0.04 × age), and the gradient accommodative convergence over accommodation ratio (3.97 - 0.08 × age) serve as a guide.ConclusionsThe study provides expected data that optometrists may use with similar aged Black African populations.

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Topical Review: Assessment of Binocular Sensory Processes in Low Vision.

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