Abstract
Heterophoria requires treatment (if decompensated) if it is causing symptoms, decreased performance, or is likely to deteriorate if left untreated. Factors that can cause a heterophoria to decompensate are reviewed, including changes in the working environment, the visual system, or systemic factors. The symptoms of decompensated heterophoria are described, and it is noted that these are nonspecific (can have other causes). A battery of tests is required to diagnose decompensated heterophoria, including cover test, aligning prism (associated phoria), fusional reserves, and foveal suppression or stereoacuity. These tests, and sensitivity and specificity, are summarised. It is noted that the aligning prism should be measured with a fixation disparity test that is naturalistic and has a good foveal and peripheral fusion lock (e.g., the Mallett unit). Vergence facility is a useful additional test. In view of the increasing prevalence of myopia, changes to binocular vision associated with myopia development are described.
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