I’ve been privileged to give many optometric continuing education lectures, and while “on the circuit” gotten to know some of the leading presenters in our field. One of them is Dr. Paul Karpecki, and awhile back I called him on the carpet, good naturedly, for an approach to binocular vision problems that involved prism prescription while downplaying the role of office-based vision therapy. After all, as related to convergence insufficieny in particular, we know from the gold standard CITT study that other interventions pale in comparison to what can be accomplished with office-based vision therapy supported by prescribed home therapy procedures.
I was therefore delighted when our primary colleague, Dr. Charles Fitzpatrick, eamiled me this afternoon to point out the current Clinical Pearl Of The Week from the Review of Optometry. In it Dr. Karpecki writes:
“It’s important to remember that symptoms of asthenopia can mimic those associated with dry eye disease—including burning, stinging, irritation, pain, fatigue secondary to extensive computer use, and/or even headaches.
Outside of dry eye disease, potential causes of these symptoms include: computer vision syndrome, convergence insufficiency, proprioception disparity and vertical imbalance.
Many patients with the aforementioned visual system conditions also exhibit a stare reflex, and actually may have mild signs of dry eye disease. These clinical signs quickly respond to therapy, but the dry eye-like symptoms won’t disappear until the underlying cause of the asthenopia is treated. This may require vision therapy or spectacles with prism, depending on the cause.”
Kudos to Dr. Karpecki!