The College of Optometrists

Principles of examining and managing patients with an anomaly of binocular vision

You should assess the patient’s binocular vision as an integral part of a sight test because prescribing decisions for spectacles or contact lenses may affect the patient’s binocular status. For example, there can be a risk of over-minussing a young esophore or under-minussing a young exophore. 
If you examine a patient who has an anomaly of binocular vision but they are asymptomatic and the anomaly is not amblyogenic, you may not need to correct the anomaly. In this case you should inform the patient, or their parent or carer, and advise them on the management option you think is most appropriate. A rare exception to this advice occurs if it is likely that an anomaly will worsen, for example decompensate, if left untreated.73 
You should use visual acuity tests that are appropriate for the age of the patient,74 whenever possible using crowded tests. See section on Examining younger children
You should be aware of the various options for treating patients with binocular vision anomalies. These include both refractive techniques and exercises; you should be able to advise the patient about these. 


73 Evans BJW (2007) Pickwell’s binocular vision anomalies. Oxford: Elsevier
74 Royal College of Ophthalmologists (2012) Guidelines for the management of strabismus in childhood [accessed 27 Oct 2017]

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