In the last 100 years, there appears to have been a myopic shift in clinic-based populations and myopia prevalence appears to follow a predictable pattern with age.

Citation: Leat SJ, Chan LL-L, Maharaj P-D, et al. Binocular vision and eye movement disorders in older adults. Invest Ophthalmol Vis Sci. 2013;54:3798-3805. DOI:10.1167/ iovs.12-11582 PURPOSE. To determine the prevalence of binocular vision (BV) and eye movement disorders in a clinic population of older adults. METHODS.Retrospective clinic data were abstracted from files of 500 older patients seen at the University of Waterloo Optometry Clinic over a 1-year period. Stratified sampling gave equal numbers of patients in the 60 to 69, 70 to 79, and 80þ age groups. Data included age, general and ocular history and symptoms, use of antidepressants, a habit of smoking, refraction, visual acuity, BV and eye movement status for the most recent full oculo-visual assessment, and an assessment 10 years prior. The prevalence of any BV or eye movement abnormal test (AT) result, defined as a test result outside the normal range, was determined. This included strabismus (any) or phoria; incomitancy; poor pursuits; and remote near point of convergence (NPC). The prevalence of significant BV disorders (diagnostic entities, i.e., a clinical condition that may need treatment and may have functional implications) was also determined.RESULTS. The prevalence of any BV or eye movement AT was 41%, 44%, and 51% in the 60 to 69, 70 to 79, and 80þ age groups, respectively. These figures were lower for 10 years earlier: 31%, 36%, and 40% for ages 50 to 59, 60 to 69, and 70þ, respectively. The prevalence of any BV or eye movement disorder was 27%, 30%, and 38% for the three age groups and 17%, 19%, and 24% for 10 years prior. Age and use of antidepressants most commonly predicted BV or eye movement AT or disorder.CONCLUSIONS. BV disorders are common among older adults.Keywords: aging, heterophoria, binocular vision disorders, eye movement disorders T here has been little attention paid to age-related changes in binocularity or to the prevalence of binocular vision (BV) disorders in older adults. 1 The definition of what is included as a BV disorder differs between studies, making them hard to compare. Despite this, it appears that the overall prevalence of BV disorders in prepresbyopic clinic populations is quite high, ranging from 10% 2 when only near esophoria or convergence insufficiency were included, to 21.8% 3 when any one of the following conditions were included: convergence insufficiency, basic eso-or exophoria, divergence excess, divergence insufficiency, convergence excess, or reduced fusional vergence ranges. Porcar and Martinez-Palomera 4 found a total of 15.3% who exhibited either convergence insufficiency, convergence excess, basic eso-or exophoria, or fusional vergence dysfunction in a population of university students. These studies excluded people with strabismus and the figures quoted here exclude accommodative disorders. The prevalence of strabismus has been found to be between 2.7% and 5.5% in schoolchildren [5][6][7][8][9][10][11] and is similar in the adult population. 12-14Therefore, this percentage should be ad...

The optometrists in this academic setting appear to follow the available optometric guidelines for prescribing for hyperopia. They tend to prescribe for lower levels of hyperopia than U.S. ophthalmologists.

Optometric practitioners routinely modify the subjective refraction to create the prescription. Small modifications are common, whereas larger modifications are used more sparingly. Because there is a significant amount of clinical judgment involved in determining the refractive prescription, reliance on automated or subjective refraction alone would not be prudent.

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