Magnitude of nonstrabismic binocular vision anomalies in the pediatric population in a tertiary hospital

Introduction: Nonstrabismic binocular vision anomalies (NSBVAs) are visual dysfunctions that impair clear and comfortable binocular vision, particularly during near tasks. These arise from accommodative or vergence dysfunctions and often manifest without overt strabismus. NSBVAs are commonly overlooked and can significantly affect visual efficiency, especially in children. With the growing use of digital screens, the prevalence of these anomalies in school-aged populations is rising. If left undiagnosed, they may progress to strabismic conditions, leading to impaired stereopsis. Early diagnosis and intervention, such as vision therapy, can improve visual comfort, academic performance, and overall quality of life. Objectives: The objective of this study was to assess binocular vision function in the pediatric age group and to determine the magnitude of NSBVA in children presenting with asthenopia. Materials and Methods: A hospital-based cross-sectional study was conducted over 18 months in the Department of Ophthalmology, Sapthagiri Institute of Medical Sciences and Research Center, Bangalore. A total of 300 pediatric patients meeting the inclusion criteria were enrolled. Each participant underwent a comprehensive ophthalmologic and binocular vision assessment, including history, clinical examination, and orthoptic evaluation. Results: Among the 300 participants, 52.33% were female, with the majority aged between 12 and 18 years (70.33%). Most students were from grades 9 and 10 (32.33%). The most common presenting complaint was diminution of vision. Refractive errors were newly diagnosed in 16% of the cases. All subjects demonstrated intact sensory function, whereas motor dysfunctions were evident in NSBVA patients. Accommodation excess was more common than insufficiency. Fusional vergence deficiencies were more pronounced at distance, whereas convergence insufficiency at near was less prevalent. Conclusion: NSBVA is highly prevalent among school-aged children and increases with age and academic demands. Routine screening for binocular vision anomalies should be incorporated into school vision programs to enable early intervention and prevent progression to strabismus.