Can Binocular Vision Disorders Contribute to Contact Lens Discomfort?


Here is the abstract of an article that will be published in the September issue of Optometry and Vision Science:

Purpose: To determine the relationship between binocular vision (BV) disorder and dry eye symptoms and the frequency of BV disorders in subjects with contact lens-induced dry eye symptoms.

Methods: Subjects recruited for a larger dry eye study (n = 104) completed the Ocular Surface Disease Index (OSDI) and Convergence Insufficiency Symptom Survey (CISS) to determine if symptoms assessed on these two surveys were related. Also, myopic soft contact lens wearers (n = 29) with self-reported dry eye symptoms were recruited. Subjects completed the OSDI and CISS to assess severity of dry eye and BV disorder symptoms. Basic BV and dry eye testing was performed on each subject.

Results: Severity of symptoms assessed on the OSDI and CISS was found to be significantly correlated in the larger subject group ([rho] = 0.68, p = 0.0001). This significant correlation warranted further investigation of both symptoms and clinical signs. In the group of myopic soft contact lens wearers, 48.3% had a BV disorder. This proportion appeared to be higher than previously reported prevalence estimates of BV disorders. Accommodative lag greater than or equal to 1.00 diopter was the most common BV disorder sign encountered (48.3%), and pseudo-convergence insufficiency was the most common BV disorder (31.0%).

Conclusions: Symptoms related to dry eye and BV disorders overlap. Subjects with symptoms of discomfort while wearing soft contact lenses may be experiencing a concurrent or stand-alone BV disorder. Accommodative insufficiency and pseudo-convergence insufficiency were common in the sample of myopic soft contact lens wearers. Clinicians should screen symptomatic contact lens-induced dry eye patients for BV disorders. Dry eye studies should assess basic BV function.

3 thoughts on “Can Binocular Vision Disorders Contribute to Contact Lens Discomfort?

  1. Dear Lenny,

    Thank you for sharing this clinical pearl/insight. Ironically, most contact lens specialists are focused on acuity and only one eye at a time. Their approach to blur is to typically increase the patient’s myopic prescription. It should also be noted that many patients, who have poor results from LASIK also have underlying binocular/accommodative dysfunctions. The treatment of a symptom(s) is not always the best strategy in addressing the patient’s primary problem/concern. Thanks again for this important post.


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