Clinical Effectiveness of Facility and Accuracy of Accommodation in Diagnosis of Non Strabismic Binocular Vision Anomalies in Young Adults: A Prospective Cross-sectional Observational Study

Abstract

Introduction: Orthoptic evaluation is highly recommended in children and young adults to diagnose binocular dysfunctions. Binocular vision dysfunctions may hamper academic performance in children. Accommodative facility and accommodative accuracy are two orthoptic tests to evaluate accommodative flexibility and accommodative status of eye. Aim: To investigate the effectiveness of facility and accuracy of accommodation in diagnosis of Non Strabismic Binocular Vision Anomalies (NSBVA) in young adults. Materials and Methods: This prospective, cross-sectional observational study was conducted at Optsight Eye Care in association with Amity Medical School, Gurugram, Haryana, India, from August 2020 to August 2021. A total of 175 subjects (both symptomatic and asymptomatic) with normal anterior and posterior segment findings, and aged between 18-25 years were evaluated for accommodative facility test with the help of accommodative lens flipper ±2D and for accommodative status test with the help of monocular estimation method (dynamic retinoscopy). Both the tests were done over their best corrected visual acuity after refractive error correction and the Pearson correlation test was applied to find out the correlation. Further, complete orthoptic examination was performed for all the subjects to correlate the abnormal findings from the two tests and conventional orthoptic tests. Independent sample t-test was applied to compare the accommodative facility between refractive groups. Results: Out of 175 subjects, 84 (48%) of the subjects were found to have NSBVA which included 26 (14.86%) convergence insufficiency, 30 (17.14%) with accommodative insufficiency, 25 (14.29%) with convergence insufficiency secondary to accommodative insufficiency and 3 (1.71%) with accommodative infacility. A positive correlation between binocular accommodative facility and status of accommodation was found with a p-value <0.001 (r=0.51). Conclusion: Status of accommodation and facility test can help to differentiate the accommodative and vergence problems making examination less time consuming. Both of these procedures should be a part of general routine eye examination protocol in the young adult group, so that detection of these anomalies become less time consuming and patient gets benefitted from early intervention.

Keywords

• binocular dysfunction
• convergence insuficiency
• orthoptic evaluation