Integrating binocular vision assessment in refractive surgery work-up: Proposition and protocol

Area of Science:

• Ophthalmology
• Optometry
• Vision Science

Background:

• Refractive surgery is common for visual impairment, but complications like regression and ectasia can occur.
• Increased screen time leads to asthenopia, glare, and focusing issues, suggesting non-strabismic binocular vision anomalies (NSBVA).
• NSBVA can be misdiagnosed as refractive under-correction or regression post-surgery.

Purpose of the Study:

• To guide refractive surgeons in diagnosing and treating post-refractive surgery NSBVA.
• To emphasize the importance of pre-operative binocular vision assessment.
• To provide an algorithmic approach for managing NSBVA in refractive surgery patients.

Main Methods:

• Review of current literature and clinical practices.
• Development of a case-based and algorithmic approach for diagnosis and treatment.
• Emphasis on incorporating binocular vision assessment into pre-operative evaluations.

Main Results:

• Vision therapy, both home- and office-based, significantly improves visual acuity in most patients with NSBVA.
• Timely diagnosis of NSBVA prevents unnecessary and potentially harmful re-correction procedures.
• Pre-operative screening can identify patients at risk for developing NSBVA post-refractive surgery.

Conclusions:

• Diagnosing and treating NSBVA is crucial for managing visual complaints after refractive surgery.
• Integrating binocular vision assessment pre-operatively is essential for refractive surgery candidates.
• A structured approach to NSBVA can enhance patient outcomes and quality of life.