{"id":45932,"date":"2023-04-03T00:02:59","date_gmt":"2023-04-03T04:02:59","guid":{"rendered":"https:\/\/reviewofmm.com\/?p=45932"},"modified":"2023-03-30T10:40:18","modified_gmt":"2023-03-30T14:40:18","slug":"myopia-management-binocular-vision-issues-treat-simultaneously-or-bv-first","status":"publish","type":"post","link":"https:\/\/reviewofmm.com\/myopia-management-binocular-vision-issues-treat-simultaneously-or-bv-first\/","title":{"rendered":"Myopia Management &#038; Binocular Vision Issues: Treat Simultaneously or BV First?"},"content":{"rendered":"<p><strong>April 3, 2023<\/strong><\/p>\n<p><strong>By Tim Fricke, BOptom, MSc, FAAO, Consultant, Brien Holden Vision Institute<\/strong><\/p>\n<blockquote><p><span style=\"font-weight: 400;\">It is worth looking for mutual benefits \u2014 constructive interference \u2014 between myopia and binocular vision issues to enable successful, simultaneous management. Intelligent assessment and diagnosis of each condition and understanding how one can affect the other will enable this.\u00a0<\/span><\/p><\/blockquote>\n<p><span style=\"font-weight: 400;\"><img decoding=\"async\" loading=\"lazy\" class=\"alignright wp-image-42993\" src=\"https:\/\/reviewofmm.com\/wp-content\/uploads\/2022\/04\/GettyImages-668760879-300x201.jpg\" alt=\"Myopia Management and Binocular Vision\" width=\"404\" height=\"271\" srcset=\"https:\/\/reviewofmm.com\/wp-content\/uploads\/2022\/04\/GettyImages-668760879-300x201.jpg 300w, https:\/\/reviewofmm.com\/wp-content\/uploads\/2022\/04\/GettyImages-668760879-1024x685.jpg 1024w, https:\/\/reviewofmm.com\/wp-content\/uploads\/2022\/04\/GettyImages-668760879-150x100.jpg 150w, https:\/\/reviewofmm.com\/wp-content\/uploads\/2022\/04\/GettyImages-668760879-768x513.jpg 768w, https:\/\/reviewofmm.com\/wp-content\/uploads\/2022\/04\/GettyImages-668760879-1536x1027.jpg 1536w, https:\/\/reviewofmm.com\/wp-content\/uploads\/2022\/04\/GettyImages-668760879-2048x1369.jpg 2048w, https:\/\/reviewofmm.com\/wp-content\/uploads\/2022\/04\/GettyImages-668760879-1320x883.jpg 1320w\" sizes=\"(max-width: 404px) 100vw, 404px\" \/>Myopia and binocular vision issues are among the most common conditions affecting children. Myopia prevalence varies most wildly \u2014 age, location, and other variables give rates anywhere between 2% (e.g., 7-year-olds in Northern Ireland,<\/span><sup><span style=\"font-weight: 400;\">1<\/span><\/sup><span style=\"font-weight: 400;\"> and 8-year-olds in Ethiopia<\/span><sup><span style=\"font-weight: 400;\">2<\/span><\/sup><span style=\"font-weight: 400;\">) and 80% (e.g., 15-year-olds in South Korea,<\/span><sup><span style=\"font-weight: 400;\">3<\/span><\/sup><span style=\"font-weight: 400;\"> and a subgroup of 18-year-olds in Israel<sup>4<\/sup><\/span><span style=\"font-weight: 400;\">). The prevalence of binocular vision issues hovers between about 5% and 25% depending more on definitions than age and location.<\/span><sup><span style=\"font-weight: 400;\">5,6<\/span><\/sup><span style=\"font-weight: 400;\"> At these rates, we are bound to find both issues coexisting in children presenting for care.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The Occam\u2019s razor philosophy suggests the solution with the fewest components is most likely correct. So, rather than looking at myopia and binocular vision issues as two independent problems when they present together in the same child, it is tempting to look for a single causative factor of both, then target management at that. However, while there are theories linking causative factors for myopia and binocular vision issues, there is little evidence in support. In practical terms, no binocular vision treatments will make myopia disappear, nor vice versa. So at some point, we will likely need to target treatments independently.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Binocular vision issues and myopia commonly cause symptoms that our patients want resolved, with short-term relief and long-term normalization and\/or harm minimalization. The following principles and tips may be useful in these cases.<\/span><\/p>\n<p><strong>Ensure a thorough assessment and reach considered diagnoses:<\/strong><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Some binocular vision issues (e.g., accommodative excess, with or without convergence insufficiency) can generate pseudo-myopia (accommodation that remains during non-cycloplegic refractions). Cycloplegic refraction is the best way to differentiate pseudo-myopia from real myopia.<\/span><\/li>\n<li><span style=\"font-weight: 400;\">There are many ways to assess accommodation and vergence. Baseline assessment could include a battery such as history (i.e., are their symptoms consistent with a binocular vision issue?), posture (i.e., distance and near phoria for vergence<\/span><sup><span style=\"font-weight: 400;\">7<\/span><\/sup><span style=\"font-weight: 400;\"> and dynamic retinoscopy for accommodation<\/span><sup><span style=\"font-weight: 400;\">8<\/span><\/sup><span style=\"font-weight: 400;\">), vergence ranges,<\/span><sup><span style=\"font-weight: 400;\">9<\/span><\/sup><span style=\"font-weight: 400;\"> accommodative facility,<\/span><sup><span style=\"font-weight: 400;\">10<\/span><\/sup><span style=\"font-weight: 400;\"> and AC\/A ratio.<\/span><sup><span style=\"font-weight: 400;\">11<\/span><\/sup><span style=\"font-weight: 400;\"> Results should enable the classification of binocular vision as normal, excess (accommodation, vergence, or both), or insufficient (accommodation, vergence, or both).<\/span><sup><span style=\"font-weight: 400;\">12<\/span><\/sup><\/li>\n<\/ul>\n<p><strong>Recognize the possibility of <i>destructive interference<\/i> in the simultaneous management of myopia and binocular vision issues:<\/strong><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Accommodation is affected by low-dose atropine for myopia control, even at the lowest concentration of 0.01%.<\/span><sup><span style=\"font-weight: 400;\">13<\/span><\/sup><span style=\"font-weight: 400;\"> When concentration is matched to individual pigmentation, low-dose atropine rarely has symptomatic accommodation effects. A significant exception is when there is pre-existing accommodation insufficiency. Even an asymptomatic tendency to accommodative insufficiency can become symptomatic after starting low-dose atropine for myopia control. If managing myopia with low-dose atropine in someone with accommodation insufficiency, baseline binocular vision measurements are essential, as is either forewarning your patient\/family, or averting the complication by simultaneously prescribing bifocal<\/span><sup><span style=\"font-weight: 400;\">14<\/span><\/sup><span style=\"font-weight: 400;\"> or progressive addition<\/span><sup><span style=\"font-weight: 400;\">15<\/span><\/sup><span style=\"font-weight: 400;\"> spectacles.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Bifocal and progressive addition spectacle lenses show no anti-myopia effect in the presence of convergence insufficiency.<\/span><sup><span style=\"font-weight: 400;\">14,15<\/span><\/sup><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Accommodation excess is unlikely to be controlled by orthokeratology, anti-myopia soft contact lenses,<\/span><sup><span style=\"font-weight: 400;\">16,17<\/span><\/sup><span style=\"font-weight: 400;\"> or spectacle<\/span><sup><span style=\"font-weight: 400;\">18<\/span><\/sup><span style=\"font-weight: 400;\"> lenses. Additionally, the anti-myopia effect of these treatments may rely on predictable peripheral refraction outcomes<\/span><sup><span style=\"font-weight: 400;\">19<\/span><\/sup><span style=\"font-weight: 400;\"> that may not occur in accommodation excess patients. While there is little evidence to guide us, I suspect accommodation excess patients are unlikely to do well with these myopia management options.<\/span><\/li>\n<\/ul>\n<p><strong>Recognize the possibility of <i>constructive interference<\/i> in the simultaneous management of myopia and binocular vision issues:<\/strong><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Convergence excess will tend to be alleviated by plus at near. This is clearest with bifocal spectacles (reasonable anti-myopia effects)<\/span><sup><span style=\"font-weight: 400;\">14<\/span><\/sup><span style=\"font-weight: 400;\"> or progressive addition spectacles (some anti-myopia effects),<\/span><sup><span style=\"font-weight: 400;\">15<\/span><\/sup><span style=\"font-weight: 400;\"> where the baseline AC\/A ratio will indicate the likely binocular vision benefit. But it may also occur with anti-myopia soft contact lenses<\/span><sup><span style=\"font-weight: 400;\">16,17<\/span><\/sup><span style=\"font-weight: 400;\"> and spectacle<\/span><sup><span style=\"font-weight: 400;\">18<\/span><\/sup><span style=\"font-weight: 400;\"> lenses.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Accommodation excess, with or without a vergence component, may benefit from low-dose atropine.<\/span><\/li>\n<\/ul>\n<p><strong>Vision therapy is useful in treating binocular vision issues,<sup>20<\/sup> but no concurrent anti-myopia effect has been shown:<sup>21<\/sup><\/strong><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">It is hard to predict constructive interference here. Still, any optical anti-myopia option (orthokeratology, novel soft contact lenses or spectacle lenses, even bifocal spectacles) should combine well with vision therapy for convergence insufficiency.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">It is certainly worth avoiding making life harder than it needs to be! For example, accommodation insufficiency at the same time as low-dose atropine for myopia control is not recommended.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">In summary, it is worth looking for mutual benefits \u2014 constructive interference \u2014 between myopia and binocular vision issues to enable successful, simultaneous management. Intelligent assessment and diagnosis of each condition and understanding how one can affect the other will enable this.\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<table style=\"border-collapse: collapse; width: 100%;\">\n<tbody>\n<tr>\n<td style=\"width: 41.4865%; vertical-align: top;\"><img decoding=\"async\" loading=\"lazy\" class=\"alignnone size-medium wp-image-45933\" src=\"https:\/\/reviewofmm.com\/wp-content\/uploads\/2023\/03\/Tim-Fricke-2021b-small-296x300.jpeg\" alt=\"\" width=\"296\" height=\"300\" srcset=\"https:\/\/reviewofmm.com\/wp-content\/uploads\/2023\/03\/Tim-Fricke-2021b-small-296x300.jpeg 296w, https:\/\/reviewofmm.com\/wp-content\/uploads\/2023\/03\/Tim-Fricke-2021b-small-1010x1024.jpeg 1010w, https:\/\/reviewofmm.com\/wp-content\/uploads\/2023\/03\/Tim-Fricke-2021b-small-148x150.jpeg 148w, https:\/\/reviewofmm.com\/wp-content\/uploads\/2023\/03\/Tim-Fricke-2021b-small-768x778.jpeg 768w, https:\/\/reviewofmm.com\/wp-content\/uploads\/2023\/03\/Tim-Fricke-2021b-small-80x80.jpeg 80w, https:\/\/reviewofmm.com\/wp-content\/uploads\/2023\/03\/Tim-Fricke-2021b-small-45x45.jpeg 45w, https:\/\/reviewofmm.com\/wp-content\/uploads\/2023\/03\/Tim-Fricke-2021b-small.jpeg 1263w\" sizes=\"(max-width: 296px) 100vw, 296px\" \/><\/td>\n<td style=\"width: 58.5135%;\"><strong>Tim Fricke<\/strong> is an optometrist and international development practitioner. His research interests include vision development, binocular vision, epidemiology, quality of life, and access to care. He has taught pediatric and general optometry at multiple Australian, Asian, and African universities. He has been a Director at the Australian College of Optometry and the Brien Holden Foundation. He is a principal at MinneMerri Consultants, an honorary senior fellow at the University of Melbourne, and a PhD candidate at UNSW Sydney.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400; font-size: 10pt;\">References<\/span><\/p>\n<ol>\n<li><span style=\"font-size: 10pt;\"><span style=\"font-weight: 400;\">O&#8217;Donoghue L, McClelland JF, Saunders KJ, et al. <strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/20494909\/\" target=\"_blank\" rel=\"noopener\">Refractive error and visual impairment in school children in Northern Ireland<\/a><\/strong>. <\/span><i><span style=\"font-weight: 400;\">Br J Ophthalmol<\/span><\/i><span style=\"font-weight: 400;\"> 2010; <\/span>94<span style=\"font-weight: 400;\">(9): 1155-9.<\/span><\/span><\/li>\n<li><span style=\"font-size: 10pt;\"><span style=\"font-weight: 400;\">Assem AS, Tegegne MM, Fekadu SA. <strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/33750986\/\" target=\"_blank\" rel=\"noopener\">Prevalence and associated factors of myopia among school children in Bahir Dar city Northwest Ethiopia, 2019<\/a><\/strong>. <\/span><i><span style=\"font-weight: 400;\">PLoS ONE<\/span><\/i><span style=\"font-weight: 400;\"> 2021; <\/span>16<span style=\"font-weight: 400;\">(3 March): e0248936.<\/span><\/span><\/li>\n<li><span style=\"font-size: 10pt;\"><span style=\"font-weight: 400;\">Kim H, Seo JS, Yoo W-S, et al.<strong><a href=\"https:\/\/bmcophthalmol.biomedcentral.com\/articles\/10.1186\/s12886-020-1316-6\" target=\"_blank\" rel=\"noopener\"> Factors associated with myopia in Korean children: Korea National Health and nutrition examination survey 2016-2017 (KNHANES VII)<\/a><\/strong>. <\/span><i><span style=\"font-weight: 400;\">BMC Ophthalmol<\/span><\/i><span style=\"font-weight: 400;\"> 2020; <\/span>20<span style=\"font-weight: 400;\">(1): 31.<\/span><\/span><\/li>\n<li><span style=\"font-size: 10pt;\"><span style=\"font-weight: 400;\">Bez D, Megreli J, Bez M, et al. <strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/31145422\/\" target=\"_blank\" rel=\"noopener\">Association between type of educational system and prevalence and severity of myopia among male adolescents in Israel<\/a><\/strong>. <\/span><i><span style=\"font-weight: 400;\">JAMA Ophthalmol<\/span><\/i><span style=\"font-weight: 400;\"> 2019; <\/span>137<span style=\"font-weight: 400;\">(8): 887-93.<\/span><\/span><\/li>\n<li><span style=\"font-size: 10pt;\"><span style=\"font-weight: 400;\">Li L, Li B, Yang L-Y, et al. <strong><a href=\"https:\/\/pesquisa.bvsalud.org\/portal\/resource\/pt\/wpr-780620\" target=\"_blank\" rel=\"noopener\">Current situation and analysis of convergence insufficiency of primary school students in Nanchong<\/a><\/strong>. <\/span><i><span style=\"font-weight: 400;\">Int Eye Sci<\/span><\/i><span style=\"font-weight: 400;\"> 2020; <\/span>20<span style=\"font-weight: 400;\">(2): 366-9.<\/span><\/span><\/li>\n<li><span style=\"font-size: 10pt;\"><span style=\"font-weight: 400;\">Hashemi H, Nabovati P, Doostdar A, et al. <strong><a href=\"https:\/\/onlinelibrary.wiley.com\/doi\/full\/10.1111\/cxo.12522\" target=\"_blank\" rel=\"noopener\">The prevalence of convergence insufficiency in Iran: a population-based study<\/a><\/strong>. <\/span><i><span style=\"font-weight: 400;\">Clin Exp Optom<\/span><\/i><span style=\"font-weight: 400;\"> 2017; <\/span>100<span style=\"font-weight: 400;\">(6): 704-9.<\/span><\/span><\/li>\n<li><span style=\"font-size: 10pt;\"><span style=\"font-weight: 400;\">Wong EP, Fricke TR, Dinardo C. <strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/12086303\/\" target=\"_blank\" rel=\"noopener\">Interexaminer repeatability of a new, modified prentice card compared with established phoria tests<\/a><\/strong>. <\/span><i><span style=\"font-weight: 400;\">Optom Vis Sci<\/span><\/i><span style=\"font-weight: 400;\"> 2002; <\/span>79<span style=\"font-weight: 400;\">(6): 370-5.<\/span><\/span><\/li>\n<li><span style=\"font-size: 10pt;\"><span style=\"font-weight: 400;\">Rouse MW, London R, Allen DC. <strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/7072827\/\" target=\"_blank\" rel=\"noopener\">An evaluation of the monocular estimate method of dynamic retinoscopy<\/a><\/strong>. <\/span><i><span style=\"font-weight: 400;\">Optom Vis Sci<\/span><\/i><span style=\"font-weight: 400;\"> 1982; <\/span>59<span style=\"font-weight: 400;\">(3): 234-9.<\/span><\/span><\/li>\n<li><span style=\"font-size: 10pt;\"><span style=\"font-weight: 400;\">Wesson MD, Amos JF. <strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/3985105\/\" target=\"_blank\" rel=\"noopener\">Norms for hand-held rotary prism vergences<\/a><\/strong>. <\/span><i><span style=\"font-weight: 400;\">Optom Vis Sci<\/span><\/i><span style=\"font-weight: 400;\"> 1985; <\/span>62<span style=\"font-weight: 400;\">(2): 88-94.<\/span><\/span><\/li>\n<li><span style=\"font-size: 10pt;\"><span style=\"font-weight: 400;\">McKenzie KM, Kerr SR, Rouse MW, DeLand PN. <strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/3578484\/\" target=\"_blank\" rel=\"noopener\">Study of accommodative facility testing reliability<\/a><\/strong>. <\/span><i><span style=\"font-weight: 400;\">Optom Vis Sci<\/span><\/i><span style=\"font-weight: 400;\"> 1987; <\/span>64<span style=\"font-weight: 400;\">(3): 186-94.<\/span><\/span><\/li>\n<li><span style=\"font-size: 10pt;\"><span style=\"font-weight: 400;\">Jimenez R, Perez MA, Garcia JA, Gonzalez MD. <strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/15491481\/\" target=\"_blank\" rel=\"noopener\">Statistical normal values of visual parameters that characterize binocular function in children<\/a><\/strong>. <\/span><i><span style=\"font-weight: 400;\">Ophthalmic Physiological Opt<\/span><\/i><span style=\"font-weight: 400;\"> 2004; <\/span>24<span style=\"font-weight: 400;\">(6): 528-42.<\/span><\/span><\/li>\n<li><span style=\"font-size: 10pt;\"><span style=\"font-weight: 400;\">Scheiman M, Wick B. <strong><a href=\"https:\/\/www.amazon.com\/Clinical-Management-Binocular-Vision-Accommodative\/dp\/0781732751\" target=\"_blank\" rel=\"noopener\">Clinical management of binocular vision, 2<\/a><\/strong><\/span><span style=\"font-weight: 400;\">nd<\/span><span style=\"font-weight: 400;\"> ed. Philidelphia PA, USA: LW&amp;W; 2002.<\/span><\/span><\/li>\n<li><span style=\"font-size: 10pt;\"><span style=\"font-weight: 400;\">Tran HDM, Sankaridurg P, Naduvilath T, et al. <strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/34456234\/\" target=\"_blank\" rel=\"noopener\">A meta-analysis assessing change in pupillary diameter, accommodative amplitude, and efficacy of atropine for myopia control<\/a><\/strong>. <\/span><i><span style=\"font-weight: 400;\">Asia Pac J Ophthalmol<\/span><\/i><span style=\"font-weight: 400;\"> 2021; <\/span>10<span style=\"font-weight: 400;\">(5): 450-60.<\/span><\/span><\/li>\n<li><span style=\"font-size: 10pt;\"><span style=\"font-weight: 400;\">Cheng D, Woo GC, Drobe B, Schmid KL. <strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24435660\/\" target=\"_blank\" rel=\"noopener\">Effect of bifocal and prismatic bifocal spectacles on myopia progression in children: three-year results of a randomized clinical trial<\/a><\/strong>. <\/span><i><span style=\"font-weight: 400;\">JAMA Ophthalmol<\/span><\/i><span style=\"font-weight: 400;\"> 2014; <\/span>132<span style=\"font-weight: 400;\">(3): 258-64.<\/span><\/span><\/li>\n<li><span style=\"font-size: 10pt;\"><span style=\"font-weight: 400;\">Gwiazda JE, Hyman L, Norton TT, et al. <strong><a href=\"https:\/\/iovs.arvojournals.org\/article.aspx?articleid=2124678\" target=\"_blank\" rel=\"noopener\">Accommodation and related risk factors associated with myopia progression and their interaction with treatment in COMET children<\/a><\/strong>. <\/span><i><span style=\"font-weight: 400;\">Invest Ophthalmol Vis Sci<\/span><\/i><span style=\"font-weight: 400;\"> 2004; <\/span>45<span style=\"font-weight: 400;\">(7): 2143-51.<\/span><\/span><\/li>\n<li><span style=\"font-size: 10pt;\"><span style=\"font-weight: 400;\">Chamberlain P, Peixoto-de-Matos SC, Logan NS, et al. <strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/31343513\/\" target=\"_blank\" rel=\"noopener\">A 3-year randomized clinical trial of MiSight lenses for myopia control<\/a><\/strong>. <\/span><i><span style=\"font-weight: 400;\">Optom Vis Sci<\/span><\/i><span style=\"font-weight: 400;\"> 2019; <\/span>96<span style=\"font-weight: 400;\">(8): 556-67.<\/span><\/span><\/li>\n<li><span style=\"font-size: 10pt;\"><span style=\"font-weight: 400;\">Lam CS, Tang WC, Tse DY, et al. <strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24169657\/\" target=\"_blank\" rel=\"noopener\">Defocus Incorporated Soft Contact (DISC) lens slows myopia progression in Hong Kong Chinese schoolchildren: a 2-year randomised clinical trial<\/a><\/strong>. <\/span><i><span style=\"font-weight: 400;\">Br J Ophthalmol<\/span><\/i><span style=\"font-weight: 400;\"> 2014; <\/span>98<span style=\"font-weight: 400;\">(1): 40-5.<\/span><\/span><\/li>\n<li><span style=\"font-size: 10pt;\"><span style=\"font-weight: 400;\">Lam CSY, Tang WC, Tse DY, et al. <strong><a href=\"https:\/\/bjo.bmj.com\/content\/104\/3\/363\" target=\"_blank\" rel=\"noopener\">Defocus Incorporated Multiple Segments (DIMS) spectacle lenses slow myopia progression: a 2-year randomised clinical trial<\/a><\/strong>. <\/span><i><span style=\"font-weight: 400;\">Br J Ophthalmol<\/span><\/i><span style=\"font-weight: 400;\"> 2020; <\/span>104<span style=\"font-weight: 400;\">(3): 363-8.<\/span><\/span><\/li>\n<li><span style=\"font-size: 10pt;\"><span style=\"font-weight: 400;\">Damani JM, Annasagaram M, Kumar P, Verkicharla PK. <strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/34538199\/\" target=\"_blank\" rel=\"noopener\">Alterations in peripheral refraction with spectacles, soft contact lenses and orthokeratology during near viewing: implications for myopia control<\/a><\/strong>. <\/span><i><span style=\"font-weight: 400;\">Clin Exp Optom<\/span><\/i><span style=\"font-weight: 400;\"> 2022; <\/span>105<span style=\"font-weight: 400;\">(7): 761-70.<\/span><\/span><\/li>\n<li><span style=\"font-size: 10pt;\"><span style=\"font-weight: 400;\">Scheiman M, Mitchell GL, Cotter S, et al. <strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/15642806\/\" target=\"_blank\" rel=\"noopener\">A randomized clinical trial of treatments for convergence insufficiency in children<\/a><\/strong>. <\/span><i><span style=\"font-weight: 400;\">JAMA Ophthalmol<\/span><\/i><span style=\"font-weight: 400;\"> 2005; <\/span>123<span style=\"font-weight: 400;\">(1): 14-24.<\/span><\/span><\/li>\n<li><span style=\"font-size: 10pt;\">Allen PM, Radhakrishnan H, Price H, et al. <strong><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/23662960\/\" target=\"_blank\" rel=\"noopener\">A randomised clinical trial to assess the effect of a dual treatment on myopia progression: the Cambridge Anti-Myopia Study<\/a><\/strong>. <i>Ophthalmic Physiological Opt<\/i> 2013; 33(3): 267-76.<\/span><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>April 3, 2023 By Tim Fricke, BOptom, MSc, FAAO, Consultant, Brien Holden Vision Institute It is worth looking for mutual benefits \u2014 constructive interference \u2014 between myopia and binocular vision issues to enable successful, simultaneous management. Intelligent assessment and diagnosis of each condition and understanding how one can affect the other will enable this.\u00a0 Myopia and binocular vision issues are among the most common conditions affecting children. Myopia prevalence varies most wildly \u2014 age, location, and other variables give rates anywhere between 2% (e.g., 7-year-olds in Northern Ireland,1 and 8-year-olds in Ethiopia2) and 80% (e.g., 15-year-olds in South Korea,3 and a subgroup of 18-year-olds in Israel4). The prevalence of binocular vision issues hovers between about 5% and 25% depending more on definitions than age and location.5,6 At these rates, we are bound to find both issues coexisting in children presenting for care. The Occam\u2019s razor philosophy suggests the solution with the fewest components is most likely correct. So, rather than looking at myopia and binocular vision issues as two independent problems when they present together in the same child, it is tempting to look for a single causative factor of both, then target management at that. However, while there are theories linking causative factors for myopia and binocular vision issues, there is little evidence in support. In practical terms, no binocular vision treatments will make myopia disappear, nor vice versa. So at some point, we will likely need to target treatments independently. Binocular vision issues and myopia commonly cause symptoms that our patients want resolved, with short-term relief and long-term normalization and\/or harm minimalization. The following principles and tips may be useful in these cases. Ensure a thorough assessment and reach considered diagnoses: Some binocular vision issues (e.g., accommodative excess, with or without convergence insufficiency) can generate pseudo-myopia (accommodation that remains during non-cycloplegic refractions). Cycloplegic refraction is the best way to differentiate pseudo-myopia from real myopia. There are many ways to assess accommodation and vergence. Baseline assessment could include a battery such as history (i.e., are their symptoms consistent with a binocular vision issue?), posture (i.e., distance and near phoria for vergence7 and dynamic retinoscopy for accommodation8), vergence ranges,9 accommodative facility,10 and AC\/A ratio.11 Results should enable the classification of binocular vision as normal, excess (accommodation, vergence, or both), or insufficient (accommodation, vergence, or both).12 Recognize the possibility of destructive interference in the simultaneous management of myopia and binocular vision [&hellip;]<\/p>\n","protected":false},"author":290,"featured_media":42993,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[1630,1355],"tags":[4351,1258,522,1232,1611,4357,4352,1523,4356,4354,4355,41,452,698,1067,1584,4353,1365,3762,167],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Myopia Management &amp; 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