The development of myopia is the result of many factors working together, one of which may be dominant. If we can accurately grasp each factor and treat it symptomatically, myopia control will receive unexpected results. In the past, we have paid attention to factors such as retinal imaging, accommodation, occult strabismus, large astigmatism, refractive error, paracentral defocus, near eye time, environment, and height growth. But the most overlooked factor, which happens to be the most common one, is binocular vision abnormalities. Studio Ophthalmology Xu Yuan What is binocular vision? How does binocular vision abnormality develop? Binocular vision is the process by which both eyes see an object at the same time and can truly reflect the outside space. Every person, binocular vision has a gradual process of maturation and refinement, and is not born with normal binocular vision. Is there a good condition in the growth and development process? For example: genetic conditions (parental inheritance), embryonic developmental conditions (no systemic infection and medication interference), perinatal conditions (various injuries), infancy conditions (infection, trauma, impingement), etc. Is there a good developmental environment? For example: lighting environment, eye environment, learning environment, hygiene environment (infection), etc. Is there a normal state of refractive development? For example, reduced physiological hyperopia, astigmatism or refractive error. Are there any bad eye habits? Such as incorrect pencil grip to block one eye, habitual gaze in one direction, partial head writing, etc. Is there any strabismus, cryptopia, ptosis? etc., etc. In short, all factors that affect the balance of binocular vision and the normal functioning of the eye can affect the normal formation of binocular vision and lead to binocular vision abnormalities. Why does binocular vision abnormality lead to increasing myopia? The two eyes of a person are like two cameras, and the real time images taken must be strictly corresponded and transmitted to the brain in order to create a virtual space of the real world in the outside world under the central processing of the person. The closer this space is to the real, the more accurate the human judgment and operational ability, which is often referred to as tertiary vision function. The 12 extraocular muscles next to the two eyes, which are influenced by gaze tracking, tonic aggregation and dispersion, regulatory aggregation, and near perceptual aggregation, are dominated by the central system and mobilize the movements of the two eyes. The regulation of both eyes is also involved in this activity, influencing the pooling and spreading of both eyes, while the regulation is also affected by the eye movements. If the binocular vision is unbalanced, the eyes do not function properly or the regulation is not sound, it will affect binocular visual function through various channels to. Abnormal binocular visual function is mainly manifested by the lack of coordination between the eyes, or at least in one position. At this time, the task that should be completed by both eyes, will fall on one eye, even if the two eyes keep taking turns to use, it is difficult to reach half of the normal eye time. Imagine, two people lifting 60 pounds of stuff, dry 3 hours in the morning, and then 3 hours in the afternoon, if you let a person hold on 60 pounds of stuff is very difficult, even if the non-stop rotation, it is difficult to dry to half of the time of two people with the time. Not to time is tired, tired without rest will be fatigue, injury. Work has not been completed, forced to dry again, there may be eye pain and eye swelling, dry eyes, photophobia and tearing, headache and brain, blurred vision, reading the wrong line, repeated reading and frequent eye rubbing and a series of symptoms. There may even be a series of changes such as increased eye pressure and optic nerve damage. Even if you don’t have these problems, you will work out to be strong. A stronger body will show up as a bigger head, and a myopia of -3.00D will grow when the eye grows by one millimeter. This pathway of myopia development has been masked in various theories. For example, abnormalities in oculomotor parameters, including accommodative-accommodative ratio (AC/A), accommodative-accommodative ratio (CA/C), and AC/A ratio CA/C. Another example is occluded strabismus, regulatory lag, formant deprivation, and regulatory disorders. In fact, all of these problems may be related to binocular vision abnormalities. Binocular vision abnormalities leading to the continuous development of myopia can be detected and solved by various examinations mentioned above long ago. It is just that these theories are complicated and the examination equipment is not popular enough to be accepted by most ophthalmologists, thus making it difficult to be widely used. As long as we pay attention to binocular vision, we have the opportunity to detect it in time, and if we can detect it in time, we have the solution. What are the signs of binocular vision abnormalities? How to detect it early? There are many types of binocular vision abnormalities, which are mainly manifested in three major syndromes: accommodation abnormalities, pooling abnormalities and coordination abnormalities between accommodation and pooling. Adjustment abnormalities are manifested as over-adjustment or lagging adjustment; accommodation abnormalities are manifested as occluded strabismus, microstrabismus and reduced fusion range; accommodation and accommodation coordination abnormalities are mainly manifested as AC/A, CA/C, etc. These problems need to be detected by various examinations, but all of them may manifest as visual fatigue in patients. As mentioned above eye pain, eye swelling, eye dryness, eye astringency, photophobia, tearing, headache and brain surge, blurred vision, reading on the wrong line, repeated reading, frequent eye rubbing, etc., the presence of two or more of these symptoms may be visual fatigue. When the symptoms of visual fatigue appear in children, it is important to pay attention to them. In addition to fatigue symptoms, changes in the child’s head position can also be an important indicator of early detection of binocular vision abnormalities. How to solve binocular vision abnormalities? First, prevention is the main focus. For children with a genetic background, establish an optometric profile. When abnormal refractive state performance is detected, attention should be paid regardless of whether the visual acuity is normal or not, and whether there are signs of binocular vision abnormalities. Avoid the appearance of binocular vision abnormalities by improving the eye environment, strengthening outdoor activities, and correcting pencil grip posture. Second, timely detection. Unidentified side vision, eye rubbing, photophobia, and tearing, which cannot be detected as a direct cause, should be considered as binocular vision problems. The easiest thing to do is to use the same vision machine to see if the fusion range is enough. Make a red glass test (use the standard red glass in the lens box to cover a single eye, place the penlight at 1m in front of the eye, move around in a 1m square, and ask the patient to follow the gaze) to see if there is a central or peripheral compound image, and find the problem in time to solve. Third, adjust the collection training. Patients with occult exotropia or inadequate pooling need to be solved by pooling training of looking far and looking near. Patients who are found to have poor adjustment sensitivity can train the adjustment ability by reversing the beat. Fourth, eye movement training. It is found that the appearance of compound image indicates a defect in the function of a certain eye muscle or a certain part of the eye muscle. Insufficient muscle strength can be solved by exercise, and defective eye muscle function can be strengthened by exercise, but it is necessary to ensure that each muscle can be involved. If short-term training is ineffective, it is necessary to correct with prism before training. Fifth, prism correction. Prism can change the direction of light propagation, when part of the eye muscle dysfunction, eye rotation is not in place, with prism can compensate part of. Use prism to help training, and eventually can also remove the prism, only active training, there is a chance. A small percentage of those who really can’t remove the prism through training may need to wear prisms for life. Sixth, 4D training. Prisms only allow the visual axis of the two eyes to converge at a certain point; deviate from this point and they may separate. Oculomotor training can be done with the help of this one point, so that the visual axes of both eyes converge at all points on one face. Only when the visual axes of both eyes converge on all faces can both eyes successfully perform the same job. If this function is a little worse, it will only give up a glance at the point or face where he cannot converge. 4D training is a 3D training device that allows human-machine interaction. It also means that the patient’s problem is found and then the training is targeted. It is not only used for amblyopia treatment, but also to improve stereopsis by improving fusion. Improving the range of fusion is exactly the best way to solve the binocular vision function. It is believed that after binocular vision problems are taken seriously, not only will many rapidly progressing myopia be controlled, but with proper preventive measures, most of the myopia that will occur can be avoided, so let’s wait and see.