Binocular Vision Anomalies Research Articles

Binocular vision anomalies and normative data (BAND) in Tamil Nadu: report 1

BackgroundThis population‐based, cross‐sectional study was designed to determine normative data for binocular vision and accommodative testing in rural and urban populations of Tamil Nadu.MethodsA sample of 936 was determined, based on a previous pilot study. The epidemiological field work included a comprehensive eye examination and a binocular vision and accommodative assessment carried out in a total of four public schools, two each in the rural and urban arms of Chennai. An overall sample of 3,024 children between seven and 17 years of age was screened in the four schools and 920 children were included in the study.ResultsWe found significant differences in expected values from the current clinical criteria for near point of convergence (NPC) with penlight, distance and near horizontal phorias, vergence facility, accommodation convergence/accommodation (AC/A) ratio, accommodative amplitudes, monocular and binocular accommodative facility (t‐test: p < 0.001). The mean and standard deviation break/recovery values for NPC (in centimetres) with an accommodative target and penlight with red filter was 3 ± 3/4 ± 4 and 7 ± 5/10 ± 7, respectively. The mean accommodative amplitudes for the population could be estimated from the linear regression equation 16 – 0.3 × (age). The vergence facility was 12 ± 4 cycles/minute and 14 ± 4 cycles/minute in the seven to 10 and 11 to 17 age groups, respectively. Monocular accommodative facility was 11 ± 4 cycles/minute and 14 ± 5 cycles/minute and binocular accommodative facility was 10 ± 4 cycles/minute and 14 ± 5 cycles/minute in the seven to 12 and 13 to 17 age groups, respectively. The mean calculated AC/A ratio was 5.4 ± 0.6/1.ConclusionThe normative data for vergence and accommodative parameters for the Indian children between seven and 17 years of age are reported. The developmental trend of accommodation and vergence differences and significant differences in cut‐off between the current data and available literature are reported. These differences have clinical implications for the interpretation, diagnosis and management of anomalies of binocular vision.

Is there an association between convergence insufficiency and refractive errors?

Background: Refractive errors and convergence insufficiency play major roles in reading efficiency. Uncorrected refractive errors are a primary cause of binocular anomalies, including convergence insufficiency. Symptoms of asthenopia in both refractive and binocular vision anomalies are similar. Despite the relationships that exist between them, the extent of association between refractive errors and convergence insufficiency has not been studied extensively.Aim: The aim of this study was to determine the prevalence of convergence insufficiency and refractive errors and investigate their associations with gender and age in a sample of high school children.Methods: The study design was cross-sectional and comprised data from 1056 African high school students aged 13–18 years, who were randomly selected from 13 high schools in uMhlathuze municipality in the province of KwaZulu-Natal, South Africa. In the final sample, 403 (38%) were males and 653 (62%) were females. The participants’ mean age and standard deviation were 15.89 ± 1.58 years and median age was 16 years. Refractive errors, heterophoria, near point of convergence, fusional vergences and accommodative functions were evaluated.Results: Prevalences for convergence insufficiency were as follows: low suspect 12.4% (confidence interval, [CI] 10.2–14.4), high suspect 6.3% (CI, 5.0–7.9), definite 4.6% (CI, 3.4–5.9), and pseudo-convergence insufficiency 2.1% (CI, 1.2–3.0). Refractive errors were: hyperopia 6.8% (CI, 5.3–8.4), myopia 6.0% (CI, 4.6–7.5), astigmatism 2.3% (CI, 1.8–3.2), anisometropia 1.3% (CI, 0.7–2.0) and emmetropia 86.2% (CI, 85.1–89.1). There were no significant associations between convergence insufficiency and gender (p = 0.32), age (p = 0.38), grade levels (p = 0.99) or refractive errors (p = 0.08).Conclusion: The prevalence of clinically significant convergence insufficiency and refractive errors was low in this sample of black high school students in South Africa, and there was no significant correlation between them.

Clinical profile of nonstrabismic binocular vision anomalies in patients with asthenopia in North-East India

Aim: To report the clinical profile of non-strabismic binocular vision anomalies (NSBVA) in patients with asthenopia in North-East India. Materials and methods: A hospital based study was conducted on 131 patients from age group 10-40 years attending the vision therapy clinic. Patients were divided into the age groups 10-20 years, 21-30 years and 31-40 years. A detailed orthoptic evaluation was carried out including sensory and motor testing and a diagnosis was made comparing various orthoptic parameters of the particular patients. Results: Of the 131 patients, 81 were female and 50 were male. The number of patients was 62 in the 10-20 years age group, 49 in 21-30 years age group and 20 in 31-40 years age group. The prevalence of NSBVA in age group 10-20 years was 69.35%, 21-30 years was 67.35% and 31-40 years was 50.00%. It was observed that the most common NSBVA was convergence insufficiency across all age groups followed by accommodative insufficiency and convergence excess. Conclusion: Early detection of NSBVA is important because these deviations may decompensate without treatment and become strabismic resulting in loss of stereopsis and development of suppression. Early detection and treatment provides best opportunity for academic success in school going age groups.

A review of the classification of nonstrabismic binocular vision anomalies

There are conflicting and confusing ideas in literature on the different types of accommodative and vergence anomalies as different authors turn to classify them differently. This paper sought to review literature on the different classifications and types of nonstrabismic binocular vision anomalies and harmonize these classifications. Search engines, namely Google scholar, Medline, Cinahl and Francis databases, were used to review literature on the classification of accommodative and vergence dysfunctions using keywords like &lt;em&gt;binocular vision dysfunctions&lt;/em&gt;, &lt;em&gt;classification of nonstrabismic binocular vision disorders or anomalies&lt;/em&gt;, &lt;em&gt;accommodative disorders/anomalies classification&lt;/em&gt; and &lt;em&gt;vergence disorders/anomalies classifications&lt;/em&gt;, and included works that described these anomalies. Nonstrabismic binocular vision anomalies are classified as accommodative and vergence anomalies. There are three different major types of accommodative anomalies, namely accommodative insufficiency, accommodative infacility (accommodative inertia), and accommodative excess (accommodative spasm), and seven different types of vergence anomalies (convergence insufficiency, convergence excess, divergence insufficiency, divergence excess, basic esophoria, basic exophoria and fusional vergence dysfunctions), which are functional in origin. Functionally, there is a commonly reported interaction between accommodative and convergence insufficiency referred to as pseudoconvergence insufficiency. Accommodative paralysis (subtype of accommodative insufficiency) and vergence anomalies – &lt;em&gt;i.e.&lt;/em&gt;, convergence paralysis, convergence spasm and divergence paralysis – are non-functional in origin with underlying systemic disease etiologies. Systemic convergence insufficiency, associated with subnormal accommodation, is a non-functional interaction between the accommodative and convergence insufficiency. The classification of nonstrabismic binocular vision anomalies is based on the description of the clinical signs and the underlying etiology either functional or non-functional in origin. Proper diagnosis and management involves investigation of the underlying etiology in addition to the battery of binocular vision test procedures.

Binocular Vision Anomalies and Normative Data (Band) In Tamilnadu – Study Design and Methods

Purpose: To report the study design and methods of the “Binocular Vision Anomalies and Normative Data” (BAND) study in school children in Tamilnadu. Methods: This is a cross-sectional study with an estimated sample size of 936 in rural and urban arms of Tamilnadu. A total of four schools with similar socio-economic factors have been selected in the rural and urban arm and children between 7 and 17 years of age are included based on simple random sampling. All children will undergo an initial screening protocol, followed by comprehensive binocular vision assessment. Children who are asymptomatic and who pass the comprehensive binocular vision assessment protocol will be included in the normative data study and children who fail the binocular vision assessment protocol will be included in the binocular vision prevalence study. Vision therapy will be provided to children with symptomatic BV anomalies and binocular vision assessment will be repeated after vision therapy. The primary objectives are to calculate prevalence estimates of binocular vision (BV) anomalies, and development of normative data. After the prevalence estimates are calculated, receiver operating characteristic (ROC) analyses will be performed for the binocular vision tests to find the tests that have the maximum sensitivity and specificity. After the ROC analyses, re-assessment of prevalence with the minimum test battery will be carried out. Conclusion: This study is expected to provide the prevalence data for binocular vision anomalies in rural and urban Tamilnadu and normative data for binocular vision testing.

Distribution of Binocular Vision Anomalies and Refractive Errors in Iranian Children With Learning Disabilities

Background: Visual problems in children contribute to learning disorders, which are one of the most influential factors in learning. Objectives: The aim of the present study was to determine the prevalence of refractive and binocular vision errors in children with learning disorders. Patients and Methods: In this cross-sectional study, 406 children with learning disorders with a mean age of 8.56 ± 2.4 years were evaluated. Examinations included the determination of refractive errors with an auto-refractometer and static retinoscopy, measurement of visual acuity with a Snellen chart, evaluation of ocular deviation, and measurement of stereopsis, amplitude of accommodation, and near point of convergence. Results: Of the 406 participants, 319 (78.6%) were emmetropic in the right eye, 14.5% had myopia, and 6.9% had hyperopia according to cycloplegic refraction. Astigmatism was detected in 75 (18.5%) children. In our study, 89.9% of the children had no deviation, 1.0% had esophoria, and 6.4% had exophoria . In addition, 2.2% of the children had suppression. The near point of convergence ranged from 3 to 18 cm, with a mean of 10.12 ± 3.274 cm. Moreover, 98.5 and 98.0% of the participants achieved complete vision with the best correction in the right and left eye, respectively. The best corrected visual acuity in the right and left eye was achieved in 98.5 and 98.0% of the children, respectively. Conclusions: The pattern of visual impairment in learning-impaired children is not much different from that in normal children; however, because these children may not be able to express themselves clearly, lack of correct diagnosis and appropriate treatment has resulted in a marked defect in recognizing visual disorders in these children. Therefore, gaining knowledge of the prevalence of refractive errors in children with learning disorders can be considered the first step in their treatment.

Frequency of refractive errors and binocular vision anomalies in children with learning disability

SummaryPurposeTo determine the frequency of refractive errors and binocular vision anomalies in children with learning disability.MethodsIn a cross‐sectional study, 406 children with learning disability were selected by systematic sampling from the clinic of psychiatry, Emam Hosein hospital, Tehran, Iran. The mean age of the children was 8.56 ± 2.40 years (range: 5.00–14.00 years). After excluding the subjects with history of eye surgery and including criterias, examinations were carried out by experienced optometrist. Ophthalmic tests included: cycloplegic autorefraction, visual acuity, cover test, amplitude of accommodation, near point of convergence and stereopsis. Myopia and hyperopia were defined as spherical equivalent less than −0.50 Diopter (D) and more than +1.00 D. respectively. Astigmatism was defined as cylinder power worse than 0.75 D.ResultsThe frequency of myopia, hyperopia and astigmatism were 14.50%, 6.90% and 18.50% in children with learning diability respectively. Esophoria and exophoria were found in 1.00% and 6.40% of the children respectively. The optimal visual acuity was found in 98.50 % of the subjects.The frequency of exotropia, esotropia and cyclotropia were found in 1.50%, 1.00% and 0.20 % respectively. Suppression was found in 2.20% of the children. The means amplitude of accommodation and near point of accommodation were 15.53 diopter and 10.12 cm in these subjects, respectively.ConclusionsThe results of this study indicated that the frequency of refractive errors and binocular vision anomalies in children with learning disabilities are similar to normal children and are not the main causes of learning disability.

Normative data for near point of convergence, accommodation, and phoria.

Background:Measurement of for near point of convergence (NPC), amplitude of accommodation (AA) and phoria are important components of diagnosing nonstrabismic binocular vision anomalies. There is a huge variation in the normative data established for orthoptic parameters because of the variation in measurement technique. There are only limited studies for normative data based on nonclinical population in Indian population. Therefore, we aim estimate the normative values for NPC, AA, and phoria measurement in Indian population using techniques, which has good repeatability and reliability.Materials and Methods:Subjects between the age group 10-35 years participated in this prospective cross-sectional study. A self-administered symptom questionnaire was used to exclude patients with asthenopic symptoms. Clinical techniques which have good repeatability and reliability were used. NPC was measured using pen light red, green glass test. AA was measured using minus lens technique. Horizontal and vertical phoria at distance and near was measured using modified Thorington method.Results:One hundred and fifty subjects participated in the study. We found that NPC receded with age, which could because of the increase in horizontal phoria at near with age. The mean normative value for objective NPC, break and recovery of subjective NPC, monocular and binocular AA, horizontal and vertical phoria at distance and near for the three age groups are reported in the study.Conclusion:The data presented in this study can be used as a cut-off by eye care practitioners while diagnosing convergence, accommodation related anomalies in Indian population.

Symptomatology associated with accommodative and binocular vision anomalies

PurposeTo determine the symptoms associated with accommodative and non-strabismic binocular dysfunctions and to assess the methods used to obtain the subjects’ symptoms. MethodsWe conducted a scoping review of articles published between 1988 and 2012 that analysed any aspect of the symptomatology associated with accommodative and non-strabismic binocular dysfunctions. The literature search was performed in Medline (PubMed), CINAHL, PsycINFO and FRANCIS. A total of 657 articles were identified, and 56 met the inclusion criteria. ResultsWe found 267 different ways of naming the symptoms related to these anomalies, which we grouped into 34 symptom categories. Of the 56 studies, 35 employed questionnaires and 21 obtained the symptoms from clinical histories. We found 11 questionnaires, of which only 3 had been validated: the convergence insufficiency symptom survey (CISS V-15) and CIRS parent version, both specific for convergence insufficiency, and the Conlon survey, developed for visual anomalies in general. The most widely used questionnaire (21 studies) was the CISS V-15. Of the 34 categories of symptoms, the most frequently mentioned were: headache, blurred vision, diplopia, visual fatigue, and movement or flicker of words at near vision, which were fundamentally related to near vision and binocular anomalies. ConclusionsThere is a wide disparity of symptoms related to accommodative and binocular dysfunctions in the scientific literature, most of which are associated with near vision and binocular dysfunctions. The only psychometrically validated questionnaires that we found (n=3) were related to convergence insufficiency and to visual dysfunctions in general and there no specific questionnaires for other anomalies.

Visual performance and ocular abnormalities in deaf children and young adults: a literature review

Visual defects are common in deaf individuals. Refractive error and ocular motor abnormalities are frequently reported, with hyperopia, myopia, astigmatism and anomalies of binocular vision, all showing a greater prevalence in deaf individuals compared with the general population. Near visual function in deaf individuals has been relatively neglected in the literature to date. Comparisons between studies are problematic due to differences in methodology and population characteristics. Any untreated visual defect has the potential to impair the development of language, with consequences for education more generally, and there is a need to improve screening and treatments of deaf children.

The relationship between binocular vision symptoms and near point of convergence

Aim and Background:Due to the relatively high prevalence of binocular vision anomalies, a regular examination including tests for assessment and determination of these anomalies is necessary. The aim of this study was to assess the relationship between near point of convergence (NPC) and near binocular vision symptoms and finding of an NPC cutoff point for symptoms in university students.Materials and Methods:In this cross-sectional study, 124 students of different majors of Zahedan University of Medical Sciences were randomly selected. If they met the inclusion criteria, they were divided into two groups (symptomatic and asymptomatic) according to the convergence insufficiency symptom survey questionnaire. For NPC measurement, a small isolated letter E of approximately 20/30 size on a metal rod was used. After data collection, data were analyzed in SPSS.17 software (SPSS for Windows, SPSS Inc., Chicago, IL) using descriptive and analytical statistics, including Mann–Whitney U test and receiver operating characteristic (ROC) curve.Results:The mean NPC findings in the symptomatic and asymptomatic groups were 11.7 ± 5.0 and 8.4 ± 3.4 cm, respectively, with a significant difference between the two groups (P < 0.001). The ROC curve suggests an NPC cutoff point of 9.5 cm for the presence of symptoms with the testing procedures used in this study.Conclusion:The determination of NPC is helpful in the differentiation of symptomatic from asymptomatic subjects.

Why do words jump? An exploration of visually symptomatic readers

Aim: To provide an insight into the current issues in assessing visually symptomatic readers and the role of the orthoptist in the management of these patients. Methods: A literature-based review was undertaken to investigate the assessment of patients presenting with visual symptoms associated with reading. Areas related to binocular vision and visual stress, visual discomfort and illusions are covered. The importance of differentiating between the correction of visual discomfort and the correction of dyslexia is also highlighted. Results: Visual symptoms associated with reading are common, particularly in struggling readers, and the incidence of binocular vision anomalies in these patients is high. An evidence base spanning more than 40 years has demonstrated that binocular vision anomalies are common in those who complain of symptoms when reading and that correction of these anomalies is associated with improvement in reading function. The production of visual distortions and discomfort and links with reading have been noted in the literature. The use of colour has also been advocated to reduce visual discomfort associated with reading, and theories of pattern glare, noise exclusion and hyperexcitability are still being pursued to try to improve our understanding of how colour affects visual processing and can reduce symptoms of headache and visual discomfort. In addition binocular vision anomalies and distortion of text known as visual stress can coexist, and differential diagnosis is required when trying to improve visual comfort when reading, thus providing a role for the orthoptist in such cases. Conclusions: Orthoptists can play a vital role in the assessment of visually symptomatic readers and should modify their assessment, as well as considering a range of treatments when assessing visually symptomatic readers. They should, however, be clear that treating visual symptoms is not treatment for dyslexia per se but that alleviation of visual symptoms associated with reading can be beneficial to those with reading discomfort and can help those with dyslexia and those without known reading difficulties.

The Oculomotor Systems Ability to Adapt to Structural Changes Caused by the Process of Senescence: A Review

Age-related binocular vision anomalies are frequently encountered during clinical examination of mature patients. Observations of both concomitant and incomitant restrictions in eye motility indicate that all oculomotor system levels are implicated, from cortical neurons down to extraocular muscles. The system can make adaptations in response to changes induced by growth and ageing, which it does by monitoring and adjusting its own performance. This adaptive mechanism, which is important for maintaining motility, spatial orientation, and perceptual stability, seems to rely on extra-retinal information about eye position in relation to the head and trunk. Receptors in the extraocular muscles and the vestibular system, assumed to contribute to this type of information, also undergo age-related changes. This may compromise their ability to assist in the adaptive process and in potential calibrations of other neural systems. Furthermore, recent observations of a dual, common, final pathway and double insertions of distal extraocular muscles suggest that muscle and tendon receptors may facilitate other, still unresolved, functions in the visual system. Consequently, age-related changes in certain mechanoreceptors may have more severe implications for ocular motility and visual functions than previously assumed. This review aims to detail some of the most frequent neurogenic and myogenic age-related changes that take place in the human oculomotor system and relevant pre-motor structures. It will also address clinical implications of these changes and the potential adaptive mechanism they initiate.

Ocular morbidity on headache ruled out of systemic causes—A prevalence study carried out at a community based hospital in Nepal

PurposeThe association between ophthalmic anomalies and headache still needs to be investigated largely. We aimed to look for it in the context of a rural community hospital of Nepal. MethodsHundred patients with headache were investigated for ophthalmic anomalies after the probable systemic association was ruled out. All the patients were first examined by general physician, otorhinolaryngologist and psychiatrist. Ocular evaluation consisted of detailed refractive, binocularity assessment and anterior and posterior segment examination. Data were analyzed using t-test, chi-square test, multiple logistic regression, odds ratio as well as frequency and percentages. ResultsFemale above the age of 17 suffered more (p<0.05). Frontal headache was more common than occipital (p>0.05). In students and housewives frontal headache was more common (OR 3.467, 0.848–14.174; 95% CI and 1.167, 0.303–4.499; 95% CI). Refractive error was associated with frontal headache (OR, 1.429, 1.130–0.806, 95% CI). On presentation, 88% had visual acuity 6/9 or better. Forty-four percent had refractive error among whom astigmatism was more frequent (63.63%) followed by hyperopia (27.27%) and myopia (9.09%). Known eye problems were significantly associated with refractive error and binocular vision anomalies (p<0.001). Convergence insufficiency (16.25%) and fusional vergence (11.25%) deficiencies were common among unstable binocularity. ConclusionOcular anomalies co-exist with headache complains very frequently. Refractive and binocular vision anomalies need to be largely investigated in all headache patients. It is important to get a good headache history so that patients can be referred to the appropriate specialist.

The impact of binocular vision disorders on 3D display viewing

AbstractPurpose Recent advances in display technology have led to 3D display viewing becoming a commonplace activity. This exciting development has a number of implications for the vision science community. From a scientific point of view 3D displays allow us the opportunity to develop new types of tests to examine binocular function, while clinically a number of issues arise relating to visual symptoms and treatment.Methods Here we review the range of methods employed to create a 3D viewing environment and discuss the advantages and disadvantages of these technologies from a binocular vision perspective.Results We will summarise the recent research findings relating to the influence of 3D viewing on visual measures such as the AC/A and CA/C ratio and discuss how these changes may induce visual symptoms in certain patient groups. The impact of 3D viewing upon the visual system during the earlier stages of visual development will also be considered.Conclusion Findings suggest that in the mature visual system 3D display technology may induce visual symptoms in patients with normally insignificant binocular anomalies. In the immature binocular vision system, consideration should be given to the possibility of developmental problems arising from prolonged 3D display viewing. However, continued advances in 3D display technology also offer great potential for the assessment and restoration of binocular vision in patients with binocular vision anomalies such as amblyopia and strabismus.

Assessment of BV &amp; the more common anomalies of binocular vision

AbstractPurpose Binocular vision is the co‐ordination and integration of what is received from the two eyes separately into a single binocular percept. Simultaneous macular perception is the most elementary type of binocularity and represents simple sensory fusion. It occurs when the visual cortex processes separate stimuli from the two eyes at the same time and perceives them as a single image. However, true fusion occurs when both two images are fused, and some effort is made to maintain this fusion by adding a motor response. Finally these fused images of the two eyes are blended to produce a stereoscopic effect. Thus stereopsis involves a perceptual synthesis at a higher level.Methods When investigating binocular vision we should aim at assessing the presence or absence of 1) simultaneous perception, 2) fusion with some amplitude and 3) stereopsis.Results Here we examine the mechanisms of these conditions and how they reflect increasing levels of binocularity. Additionally, we will discuss the different clinical tests available to assess these conditions and what is observed when abnormal binocular vision is present.Conclusion Understanding binocular vision and how there are different levels of processing is of great importance. This talk will try to assist on the understanding of the mechanisms of binocular vision and stereopsis so we can be in better position to understand the clinical findings of our patients and what they mean in terms of cortical processing.

Binocular decompensation and diplopia after refractive laser surgery

An increasing number of people undergo refractive surgery, and even if the refractive result after surgery is perfect, the outcome is not always successful. Decompensation of binocular vision anomalies is rarely mentioned in reports considering the outcome of refractive surgery. This report presents 4 cases with binocular vision problems after refractive laser surgery. The patients were referred to the eye department of a Norwegian hospital after having received refractive laser surgery. All patients were male adults. For all patients the reason for referral was intermittent or constant binocular diplopia. Examinations were performed according to standard procedures of the hospital eye department. Two patients were diagnosed with decompensated esodeviations; they both had a history of treatment for accommodative esotropia. One patient had unstable binocular vision of unknown cause, and one had a decompensated congenital trochlear nerve paresis. Some binocular vision problems can be foreseen with proper evaluation before surgery. A thorough history and binocular evaluation are recommended before initiating refractive laser surgery.

Pickwell's Binocular Vision Anomalies, 5th Edition

Pickwell's Binocular Vision Anomalies, 5th Edition

Investigation of the causes of non-tolerance to optometric prescriptions for spectacles

To study non-tolerance to spectacle prescriptions in a busy community optometric practice, with several practitioners. A spectacle non-tolerance was defined in a pragmatic way, as a patient who had collected spectacles from the practice and subsequently returned because they were either having problems with, or were unable to wear, their new spectacles. Patients over 16 years of age, who met the above definition of non-tolerance were sequentially recruited over a 6 month period. Patients experiencing adaptation problems were first seen by a dispensing optician and any dispensing issues resolved. If the spectacle dispensing was felt to be correct, or if the non-tolerance persisted, then the patient was re-examined by an optometrist and the results analysed. Non-tolerance examinations accounted for 62 of the 3091 eye examinations during the study period. The average rate of non-tolerance, averaged across the practitioners, was 1.8%, varying from 1.3-3.3% for individual practitioners. Gender was not a factor in non-tolerance, however age was, with presbyopes accounting for 88.1%. The most common reasons for non-tolerance were, in order of decreasing frequency: prescription related (61.0%), dispensing related (22.0%), pathology (8.5%), data entry error (6.8%) and binocular vision anomalies (1.7%). Of prescription related errors, gauging the spherical element accounted for the majority of inaccuracies, followed by problems with the near/intermediate addition. In every case, the final prescription was within 1.00 D of the not tolerated, prescription; 84.4% were within +/-0.50 D. Spectacle prescription non-tolerance forms a small, but important, form of adverse reaction in optometric clinics. Most non-tolerances can be resolved by small changes, within 0.50 D, to the prescription.

Polypharmacy and the lack of oculo-visual complaints from those with mental illness and dual diagnosis

Background Individuals with mental illness (MI) and intellectual disability (ID) are characterized as dually diagnosed (DD). These individuals are known to have numerous systemic and oculo-visual anomalies. This comorbidity of conditions should elicit frequent oculo-visual complaints from these patients during the initial review of systems. A search of MedLine yielded one article that was published on oculo-visual symptomology/pain associated with MI and DD. This report appears to be the first to assess the frequency of these symptoms within these 2 unique populations. Methods A retrospective analysis of all medical records for patients (N = 202) evaluated at the Neumann Association (NA) Developmental Disabilities Service of the Illinois Eye Institute was completed. Only the records of patients who had either MI or DD and who were prescribed antipsychotics, antidepressants, anticonvulsants, or tranquilizers/anxiolytics were used for our analysis. Upon record review, 89.9% of MI and 59.4% of DD individuals met the above subject criteria. We determined the frequency of ocular anomalies, drugs taken, and complaints reported by patients during the initial review of systems. Results The most common documented side effects for the targeted drug types were decreased or blurred vision (near or far), visual hallucinations, decreased accommodation, and eyelid/conjunctiva irregularities. In our sample, the most frequent ocular anomalies encountered were astigmatism (50% MI and 37.84% DD), myopia (60.71% MI and 62.16% DD), presbyopia (35.71% MI and 37.84%DD), and blepharitis (32.14% MI and 32.43%DD). Additionally, the most frequently encountered complaints were no complaints (45.16% MI and 46.84% DD), blurry vision (17.74% MI and 17.72% DD), and need new glasses (11.29% MI and 17.72% DD). Conclusions It has been established that MI and DD populations exhibit a higher incidence of oculo-visual anomalies (uncorrected refractive error, binocular vision anomalies, ocular pathology) than noted in the general population. They are also typically taking 1 or more neuropsychotropic medications that are frequently associated with undesirable visual side effects. Individuals with MI and DD should report numerous complaints associated with the medications they take and the oculo-visual anomalies they exhibit during the initial case history and the review of systems. The data from this study suggest that this is not the case and that only about 50% of those who should have complaints actually report them.