Feature, Orthoptics Australia

A journey through binocular vision disorders

After spending 20 years developing and expanding her knowledge in binocular vision disorders, orthoptist TANIA STRAGA ventured out to establish a private orthoptic practice in Adelaide.

I became an orthoptist in 2003 upon graduating from a Bachelor of Orthoptic and Ophthalmic Sciences at La Trobe University, under the guidance of orthoptic greats including Zoran Georgievski, and Connie Koklanis.

Tania Straga

“Patients come to us with usually normal visual acuity, but significant symptoms of asthenopia or diplopia.”

It was whilst at La Trobe that I decided I wanted to pursue a career in binocular vision and paediatric eye health care. I ventured west and was appointed to a graduate position at the Women’s and Children’s Hospital Adelaide. Though I faced a steep learning curve, I realised when I arrived that I had been right about pursuing my passion in binocular vision, and revelled in the constant challenge that disorders of binocular vision posed me.

I have spent the last 20 years developing and expanding my knowledge and expertise in this area, working in public and private practice, both in paediatric and adult strabismus management. In 2020, I decided to take the step of establishing a private orthoptic practice, Adelaide Eye Therapy.

Adelaide Eye Therapy has grown from a one orthoptist practice, to now having four orthoptists and an orientation and mobility instructor on staff. We offer comprehensive orthoptic rehabilitative care, including managing childhood conditions such as amblyopia, diagnosing and treating disorders of binocular vision affecting adults and children, visual field defects, and working with patients with low vision.

In recent years, we have expanded to provide treatment for accommodative and convergence dysfunction as a result of traumatic brain injury, whether as a result of concussion or more serious injury. Patients come to us with usually normal visual acuity, but significant symptoms of asthenopia or diplopia. They have often been referred by their optometrist or ophthalmologist, though increasingly patients are coming to us via word of mouth or a Google search.

As clinicians, we listen intently to a patient, and progress through a detailed assessment of vision. Based on our objective assessment and a patient’s specific symptoms, we diagnose and then treat a disorder of binocularity by guiding the patient with specific orthoptic exercises to strengthen their binocular function.

Patients work on set exercises at home over time, and are reviewed with us in clinic to monitor progress and give expanded exercises as required. It is such an amazing experience to follow the progress of someone with significant visual discomfort, improve their function over a period of time, to then be able to complete tasks that they had all but given up on being able to achieve.

Disorders of binocular vision are commonly undervalued. Patients can present with quite nondescript and vague symptoms, and if their acuity is normal but they are symptomatic, likely it’s their binocular function that needs further investigating and treating.

Fortunately, most optometrists and ophthalmologists are perceptive to referring patients when they suspect a disorder of binocular vision. Patients themselves often can’t pinpoint what it is about their vision that is uncomfortable, but they might report having difficulty with specific tasks, or with moving their eyes into a particular area of gaze.

They might report difficulty with depth perception, motion sensitivity, heachaches or dizziness. It is rare for someone to present with frank diplopia, and when they do, you can almost always diagnose the exact cause from specific questioning regarding their exact symptomology.

A disorder of binocular vision, whether constant diplopia or poor stereopsis, can be extremely debilitating to a person. It might be that a person is no longer driving as a result of the problem (and hence has lost independence) or is no longer able to read for a meaningful amount of time.

Empowering people to regain strong binocularity is so rewarding – especially when they have walked into clinic with constant diplopia and are then fitted with a Fresnel prism that gives them back binocular vision and can get them back driving again.

As clinicians in eye health care, it is important that we all remember the importance of maintaining strong binocular function, and that we remember that vision is so much more than reading the bottom line on the chart. People with poor binocular vision or low vision in general, can usually benefit from guided orthoptic exercises, to improve and make the most of whatever level of vision they can achieve.

ABOUT THE AUTHOR: Tania Straga (BachOrth&OphtSc, GradDipGenetCounsell) is director of Adelaide Eye Therapy.

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