It is refreshing to see recognized authorities in anterior segment ocular disease such as Dr. Paul Karpecki write the following in his Review of Optometry Practice Pearl of the Week series (Vol. 5 No. 2).
WHAT DO YOU DO WHEN A PATIENT COMPLAINS OF CLASSIC DRY EYE SYMPTOMS, SUCH AS OCULAR DRYNESS AND BURNING, COMPUTER VISION SYNDROME OR END-OF-DAY CONTACT LENS INTOLERANCE, BUT YOU CAN’T DETECT ANY CLINICAL SIGNS?
One of the most common and potentially overlooked differentials is asthenopia secondary to eye alignment issues. Patients with vertical imbalance, convergence insufficiency, fixation disparity and proprioceptive disparity often will exhibit symptoms that mimic dry eye disease. They may complain of dryness, burning and irritationparticularly late in the day, while using a computer or tablet, or when reading a book. They also may report a history of frequent headaches.
Patients with asthenopia almost always have normal osmolarity readings and, with the exception of mild MGD or inferior corneal staining, usually do not exhibit any other signs of dry eye disease. For these individuals, appropriate treatment typically consists of prism use or vision therapy. Following intervention, the aforementioned symptoms frequently will improve or cease entirely.
To complement that, Review of Optometry in its current issue has a nice case report by Drs. Marc Taub and Paul Harris, respected faculty at the SCO who write:
Convergence insufficiency is most effectively treated with office-based vision therapy with home-based support. So, if your office does not offer this treatment, refer to a colleague who does. To find an optometrist in your area who offers vision therapy, visit the Optometric Extension Program Foundation or the College of Optometrists in Vision Development. No child like Jonathon should be allowed suffer and not reach his true potential. Do not keep vision therapy—the most appropriate treatment for not only convergence insufficiency but also accommodative and ocular motor dysfunction—a hidden gem. It’s time to share the wealth.
Clincal pearls … hidden gems … always wonderful to see vision therapy factored into the equation.