Binocular Vision Competency 8.2

Kay Fun PatchesCompetency 8.2: An understanding of the management of a patient with an anomaly of binocular vision

The proper interaction of the eyes under normal circumstances gives rise to Binocular Single Vision (BSV), however there are numerous conditions which can lead to a breakdown of the BV system.  The object of BV assessment is to establish the presence and severity of BV anomaly and then decide on the course of action should intervention be required.  The management plan should take into account such factors as the duration since onset of symptoms, the presence of an incomitant deviation and the potential risk of the anomaly to the development of the BV system

If you refer to the patient episode sheets you will note that  you are expected to have seen at least one patient with diplopia, one with symptomatic heterophoria and one with amblyopia.  Use these records to demonstrate evidence of your experience.

Best Form Evidence

Accurate history establishing the presence and duration of symptoms arising due to BV anomaly

Ability to assimilate test results in order to formulate a diagnosis of the BV anomaly

Logical management plan based on duration of any symptoms, test results and other risk factor

Understanding of management options available both within optometric practice and following referral to the Hospital Eye Service

Unacceptable Evidence

Inappropriate referral or treatment based on symptoms, signs and risk factors

Failure to identify patients who require treatment or onward referral due to their BV anomaly

What to study

Types of and indications for optical and non-optical methods of treatment of heterophoria and heterotropia

Causes of incomitant heterotropia and indications for referral based on symptoms and test results

Milestones in infant vision development

Examples of BV conditions that may require urgent referral

Limitations and relative merits of each type of optical and non-optical treatment, e.g. prisms vs. orthoptic exercises in convergence insufficiency

Pass/Fail criteria

Logical management decision based on presenting symptoms and test results

Knowledge of the range and basis of optical and non-optical treatment options and their indications

Understanding of alternative treatment options in the event that the chosen management plan is unsuccessful

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