Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, India.
Department of Paediatric Ophthalmology and Strabismus, Narayana Nethralaya, Bengaluru, India.
Indian J Ophthalmol. 2023 Apr;71(4):1546-1550. doi: 10.4103/IJO.IJO_3364_22.
To evaluate the effectiveness of vision therapy (VT) in patients with chronic presumed refractory dry eye disease (DED) and concurrent nonstrabismic binocular vision anomalies (NSBVAs). To propose an algorithmic approach to manage patients with refractory DED.
Thirty-two patients with chronic (>1 year) presumed refractory DED and NSBVA were prospectively evaluated. The baseline dry eye evaluation and comprehensive orthoptic evaluation were done. VT was administered by a trained orthoptist for 2 weeks. The binocular vision (BV) parameters and percentage subjective improvement were assessed after the VT.
On evaluation, 12 patients (37.5%) had both DED and NSBVA, and 20 patients (62.5%) had only NSBVA. Twenty-nine patients (90.62%) showed significant improvement in BV parameters following VT. Binocular near point of accommodation (median, range) improved from 17 (8-40) to 12 (5-26) mm (P value < 0.0001), and near point of convergence (median, range) improved from 6 (3-33) to 6 (5-14) (P value 0.004) with VT. Thirty-one patients (96.87%) reported symptomatic improvement after VT, and 62.5% of these showed more than 50% improvement in symptoms.
The present study confirms the beneficial role of VT in the treatment of patients with DED with concurrent NSBVA. It is essential to diagnose and treat NSBVA in patients with DED to ensure complete relief of symptoms and patient satisfaction. As there is a significant overlap between symptoms of dry eye disease and that of NSBVA, a complete orthoptic evaluation is recommended in all patients presenting with refractory dry eye disease related symptoms.
评估视觉疗法（VT）对慢性疑似难治性干眼症（DED）合并非斜视性双眼视觉异常（NSBVA）患者的疗效。提出一种管理难治性 DED 患者的算法方法。
前瞻性评估 32 例慢性（>1 年）疑似难治性 DED 和 NSBVA 患者。进行基线干眼评估和全面的斜视评估。由经过培训的视轴矫正师进行 2 周的 VT。VT 后评估双眼视觉（BV）参数和主观改善百分比。
评估时，12 例患者（37.5%）同时患有 DED 和 NSBVA，20 例患者（62.5%）仅患有 NSBVA。29 例患者（90.62%）BV 参数在 VT 后有显著改善。双眼近点调节（中位数，范围）从 17（8-40）改善至 12（5-26）mm（P 值<0.0001），近点集合（中位数，范围）从 6（3-33）改善至 6（5-14）（P 值 0.004）。31 例患者（96.87%）VT 后报告症状改善，其中 62.5%的患者症状改善超过 50%。
本研究证实了 VT 在治疗合并 NSBVA 的 DED 患者中的有益作用。诊断和治疗 DED 患者的 NSBVA 至关重要，以确保症状完全缓解和患者满意度。由于干眼症和 NSBVA 的症状有明显重叠，因此建议所有出现难治性干眼相关症状的患者进行全面的视轴矫正评估。
