Sari R. Schwartz, OD, FCOVD, FAAO

225 Millburn Avenue, Suite 208 B
Millburn, NJ 07041

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Sari R. Schwartz, OD, FCOVD, FAAO

(973) 804-6565

225 Millburn Avenue, Suite 208 B
Millburn, NJ 07041

Binocular Vision Disorders

Binocular Vision Disorders

Binocular basically means "2 eyes". The right and left eyes each see a different image of the world. For instance, you may have noticed that when you close one eye, and then the other, that the image from each eye is slightly different. The images from each eye must combine properly to create a final three-dimensional image. In some cases, the eyes don't work together as they should, this is called a binocular vision dysfunction. This causes various problems such as poor depth perception, blurry vision, a sense of words moving around on a page and more. Following are some brief explanations of the more common binocular vision disorders.

Vergence Dysfunctions

Your eyes are designed to work together in order to see an image as single and clear. To do this, both eyes must point and aim at the same target. This process is known as eye teaming or eye coordination.

When you are reading, your eyes must turn inward and point precisely at the same spot to see the words clearly for the length of time required. This is called convergence. Convergence Insufficiency is a condition where it is difficult to keep the eyes comfortably turned inward and pointing at the right spot to see single and clear for the length of time required to complete the task. This skill is important when looking at a computer or reading a book.

Convergence Insufficiency occurs in both children and adults, significantly interfering with reading and learning abilities. It affects 5-8% of the population.

Is Your Child "Smart" In Everything but School?

Easily Misdiagnosed as an Attention Disorder

A person with Convergence Insufficiency will find it difficult and uncomfortable to concentrate on reading and other up-close activities for extended periods of time and they will often avoid such activities. As a result, they will have difficulty paying attention when reading or doing up close work and will often avoid these tasks. This is frequently mistaken for an attention disorder.

Relationship Between Convergence Insufficiency and ADHD

Possible Signs and Symptoms Include:

Reading Slowly
Loss of Place when Reading and/or Writing
Difficulty with Concentration at Near-Distance Tasks
Eye Strain or Tired Eyes
Headaches
Blurry Vision
Double Vision (Diplopia)
Rubbing or Closing an Eye
Avoidance of Near-Distance Work

Adults with Convergence Insufficiency often experience tired eyes and headaches, especially at work, which can impact job performance and make work unbearable at times. When Convergence Insufficiency is developed later in life, teens and adults are often able to identify a visual problem because they have previously experienced normal vision. However, when a child is born with Convergence Insufficiency they are often unaware of the condition and unable to tell their parents why they are struggling with reading and learning.

If you or your child are struggling with any of these symptoms please contact us to schedule an appointment with Dr. Schwartz.

Convergence Insufficiency Treatment Trial

Accommodative Dysfunctions

In addition to accurate eye coordination, the eyes must work together to correctly focus and relax to see clearly. An Accommodative Dysfunction is an eye focusing problem that affects a child or young adult’s ability to focus their eyes properly. The eyes’ ability to focus is a vital visual function that allows us to read and perform many daily tasks. It also makes it possible for us to shift from looking at things up close to being able to see things far away.

To effectively read with accuracy in the classroom or perform in the work environment, the eyes need to accommodate (focus) in three essential ways.

The eyes must have the strength to sustain focus on the printed material for an extended period
The eyes must have a high degree of precision to see the print clearly
The eyes must have the flexibility to change focus from near to far and far to near to properly acquire visual information in the environment

For most children, these accommodative abilities are generally well developed by age 4-5 years old and usually work well into middle-age adulthood. However, an Accommodative Dysfunction can exist due to a delay in normal visual development or because of a concussion or more serious traumatic head injury (also known as a traumatic brain injury).

Possible Symptoms Include:

Frontal headaches or eye strain with sustained close work like reading
Squinting, blinking, and eye rubbing
Trouble copying from the chalkboard
Blurred vision when reading small print
Vision becomes worse by the end of the day
Reduced attention in the classroom, work and/or independent reading
Poor reading comprehension

How is it Treated?

A critical component of treatment for Accommodative Dysfunction is a special lens prescription. Using lenses in conjunction with an office-based program of Vision Therapy helps build the strength, precision, and flexibility of focusing (accommodation) to improve focusing abilities.

Oculomotor Dysfunction

In addition to the above, our eyes must track or move together. An Oculomotor Dysfunction, also known as an eye-tracking problem, occurs when there is a developmental delay or neurologic event that interferes with the brain’s ability to effectively coordinate the eyes to fixate, follow, and move from spot to spot with accuracy and good control. This condition can affect many aspects of daily life but commonly affects reading, handwriting, attention, and athletic performance.

Around each eye are six (extraocular) muscles that work together in a sophisticated manner to accurately control how we move our eyes. These muscles receive signals from the brain to coordinate their movements.

When these muscles don’t coordinate together correctly, several visual problems can occur, commonly affecting:

Fixation - the ability to maintain steady direction of the eyes on the target/object
Pursuits - the ability to follow a moving object smoothly and accurately
Saccades - the eyes' ability to jump from spot to spot accurately

Oculomotor Dysfunction is a relatively common visual condition that can affect individuals of all ages.

Those with this condition often struggle with:

General reading skills
Reading without a finger
Reading Speed and Comprehension
Coordination or Clumsiness
Sports
Attention and Concentration
Motion Sickness

How is it Treated?

Treatment may include spectacle lens, prisms, filters, and special tint prescriptions to provide symptomatic relief. In addition, in order to fully resolve the problem, an in-office program of Optometric Vision Therapy may be prescribed by Dr. Schwartz.