Are your child’s glasses still getting thicker each year, despite trying every myopia control solution and practicing responsible screen use? Myopia progression is influenced by multiple factors, and we don’t yet fully understand all of them. Over the last decade, researchers and eye care professionals have gained a much better understanding of how binocular vision problems contribute to the development and worsening of myopia (nearsightedness). These findings have made it clear that addressing binocular vision issues is now an important consideration of managing myopia. If you are looking for ways to improve your child’s myopia control, it is a good idea to make sure their binocular visual function is assessed with a comprehensive binocular vision workup to identify any binocular vision dysfunction (BVD). In this blog, we will explain how BVD can make myopia progress faster and what we can do to help.
How does binocular vision dysfunction make myopia worse?
Binocular vision dysfunction (BVD) happens when the two eyes struggle to work together to focus clearly at different distances (accommodation) or align properly on the same point (convergence). These skills are essential for children to maintain clear and comfortable vision, especially during activities like reading or using screens for long periods. Children with BVD often have difficulty keeping a stable, clear image on their retina, which can make their nearsightedness worse. Research has also shown that BVD can influence the development and progression of myopia in other ways. For example, an imbalance between focusing (accommodation) and eye alignment (convergence) is strongly linked to the onset and rapid worsening of myopia. Additionally, excessive near work that requires intense focusing can temporarily make the eye more nearsighted, though the long-term effects on eye structure are still being studied. While scientists are continuing to explore these mechanisms, it is clear that if a child has BVD, managing their myopia effectively requires addressing this issue as part of their care.
How is binocular vision dysfunction detected and diagnosed?
Binocular vision dysfunction can only be diagnosed with a comprehensive binocular vision workup by an optometrist or ophthalmologist. However, there are many signs and symptoms that may give it away even before the eye test. The most common signs and symptoms in children are:getting tired quickly during reading and/or writing, excessive blinking and eye rubbing during reading. Please refer to our binocular vision blog for more information on the signs and symptoms.
At The Eye Collective, we perform some fun screening tests on every child we see to make sure they have normal binocular visual efficiency and when we detect reduced binocular visual efficiency, we will perform more detailed investigation to diagnose the cause. It is recommended for children to have a comprehensive eye test at least once a year to detect and manage these issues in a timely manner.
How Does Binocular Vision Dysfunction Change Myopia Management Strategy?
Unfortunately, most of the myopia control interventions do not improve binocular visual efficiency and some interventions may even induce more stress on the child’s binocular visual system. Read our myopia control blogs to learn more about myopia control interventions.
Therefore, when a child is identified to have binocular vision dysfunction, we might need to utilise additional interventions to address their binocular vision dysfunction:
Atropine Eye Drops:
Low-concentration atropine eye drops have been proven effective in controlling myopia progression in children with normal binocular vision. However, caution is needed when using atropine for children with binocular vision dysfunction (BVD), as it can potentially worsen focusing (accommodation) problems. Proper evaluation and monitoring by an eye care professional are essential to ensure atropine is used safely and effectively in these cases.
Multifocal & Bifocal Spectacles:
Multifocal and bifocal spectacles are often the first line of treatment for managing certain types of binocular vision dysfunction (BVD), such as esophoria or accommodative lag. While multifocal spectacles have limited effectiveness in controlling myopia for children with normal binocular vision, they can be significantly more effective for children with specific types of BVD. In these cases, the myopia control achieved with multifocal or bifocal spectacles can sometimes rival that of specialised myopia control spectacle lenses. However, for children using multifocal spectacles solely for myopia control, regular monitoring is essential. If their myopia progression remains higher than expected, additional interventions may need to be considered to better manage their condition.
Myopia Control Contact Lenses: Soft Contact Lens & Orthokeratology Lens
In the past, it was thought that myopia control contact lenses, like MiSight by CooperVision and orthokeratology lenses, could also help with accommodation issues, similar to multifocal spectacles. After all, these lenses are modified versions of multifocal contact lenses. However, over the years, studies have shown that children adapt to multifocal contact lenses differently from adults, and these lenses don’t significantly improve binocular vision in children. While some research suggests that myopia control contact lenses may work better for children with very mild accommodation problems, this finding hasn’t been consistently proven across studies. Despite this, myopia control contact lenses can be easily combined with multifocal spectacles for tasks like classroom learning, reading and playing computer games. In fact, this combination is often the next step if multifocal spectacles alone don’t provide enough myopia control.
Vision Therapy:
Multifocal spectacles are effective for managing certain types of binocular vision dysfunction, but other types, like convergence insufficiency, may require vision therapy. Vision therapy typically involves a few in-office training sessions combined with home activities to help the two eyes work better together as a team. Common binocular vision issues, such as convergence insufficiency, often respond very well to office-based vision therapy.
Once your child’s binocular vision functions improve after therapy, they can continue with their usual myopia control intervention, with regular reviews to monitor their binocular vision status. Vision therapy does require a time commitment during the program, so it’s best to start during a quieter period at school or when they have less extracurricular activities to ensure your child has enough time and energy for the home practice.
It’s important to note that not all optometry clinics offer vision therapy. However, at The Eye Collective, we are fortunate to have experienced optometrists and vision therapists who provide in-office vision therapy to support your child’s visual needs.
In conclusion, binocular vision plays a key role in the development and progression of myopia, making it an essential factor when creating a personalised myopia control strategy. At The Eye Collective, all of our optometrists are experienced in diagnosing binocular vision issues and managing myopia in both children and adults. Book an appointment today at The Eye Collective to discover how we can support your vision care needs.