A Novel Link: Ocular Motility, Psychology And Dry Eye

Binocular vision anomalies (BVA) have become of high prevalence recently due to an increase in near work, and video display terminal (VDT) use. Many treatment approaches have been suggested for patients with refractory dry eye disease (DED) but the role of BVA and vision therapy (VT) has not been assessed till now. We investigated the prevalence of non-strabismic binocular vision anomalies (NSBVA) in patients with DED and their association with personality traits.

The study was conducted at a Tertiary Eye Care Hospital in Southern India

110 patients with refractory DED-related ocular discomfort and fatigue were examined and underwent dry eye tests, comprehensive orthoptic evaluation, and personality trait assessment (using the EYSENCK questionnaire). 59% (65) of the patients had NSBVA and were given VT by a trained orthoptist and followed up for a period of one year. The improvement was assessed as a subjective improvement in symptoms and an objective improvement in the binocular vision parameters.

Among the 65 patients diagnosed with NSBVA, 12 had accommodative insufficiency,15 had convergence insufficiency, 10 had divergence insufficiency,13 had accommodative excess & 15 had fusional vergence dysfunction. The personality trait assessment revealed that most patients (70%) were in melancholic and choleric groups and they were found to have a strong association with NSBVA. 68% had improvement in 3 months of VT & 25% improved in 4-6 months. 8% improved on dry eye therapy and 6 months of VT.

We found a significantly higher incidence of NSBVA in patients with ocular discomfort and dry eye symptoms which corresponded to melancholic, choleric personality traits. VT helps in significant symptomatic improvement in patients with ocular discomfort and fatigue and is an effective treatment modality in these patients with NSBVA.