Binocular Vision Dysfunction and Myopia Progression: A Prospective Study at a Tertiary Eye Hospital in North India
DOI:
https://doi.org/10.63682/jns.v14i21S.9267Keywords:
Myopia progression, binocular vision dysfunction, convergence insufficiency, intermittent exotropia, accommodative dysfunction, axial length, pediatric vision therapyAbstract
Purpose: To evaluate the association between binocular vision dysfunctions (BVDs) and myopia progression in children attending a tertiary eye hospital in North India.
Methods: A prospective observational study was conducted at a tertiary eye hospital in North India between April 2024 and March 2025. A total of 543 myopic children aged 6–18 years were enrolled; 369 completed 12 months of follow-up. Participants underwent comprehensive refractive, biometric, and binocular vision assessments. Myopia severity was categorized as mild (–0.50 D to –3.00 D), moderate (–3.00 D to –6.00 D), or high (> –6.00 D). BVDs were classified using Scheiman and Wick clinical criteria. Refractive progression was analyzed by changes in spherical equivalent refraction (SER) and axial length. Outcomes were compared among children with normal binocular vision, untreated BVD, and BVD receiving therapy.
Results: Normal binocular vision declined significantly with increasing myopia severity (70.3% in mild, 55.6% in moderate, and 29.7% in high myopia; p < 0.001). Convergence insufficiency (24.3%) and intermittent exotropia (24.8%) were most common in high myopes. Accommodative dysfunctions were less frequent but linked to high myopia. Over 12 months, untreated BVD was associated with greater myopia progression (–0.36 D, p = 0.0026) compared to children with normal binocular function (–0.30 D, p = 0.0023). Children receiving BVD therapy showed slower, non-significant progression (–0.27 D, p = 0.1883). Specific subtypes such as basic exophoria and accommodative infacility carried higher risk of progression. Axial length elongation paralleled refractive changes, confirming its role as a key biomarker.
Conclusion: BVDs, particularly vergence anomalies, are highly prevalent in children with moderate-to-high myopia and are associated with faster refractive progression when left untreated. Vision therapy may help stabilize myopia, though larger and longer-term studies are needed to confirm its protective role. Routine screening and early management of BVDs should be integrated into pediatric myopia control strategies.
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