Why Eye Care Providers May Not Test for Binocular Vision Disorders

Although basic sensorimotor screening is part of any comprehensive eye exam, performing the extended test is not. Therefore, sensorimotor abnormalities often go undetected. This includes testing in pediatrician offices or schools and in eye exams for adults. Therefore, many people, children, and adults, go undiagnosed and untreated for Binocular Vision Disorders.

Various limitations currently impact the doctor’s ability to test for binocular vision issues effectively and efficiently. Oftentimes, these challenges prevent the doctor from conducting the tests to uncover binocular vision issues. These issues are outlined below.

1. Quantifying Binocular Vision Testing Results

When conducting traditional testing such as the H-pattern or “Fix and Follow” tests, doctors observe the movement of the eyes using their clinical knowledge. Yet, observation, even with the most experienced doctors, is a challenge both in terms of defining the line between “normal” and “not normal,” as well as observing more subtle patterns of movement. Remembering what a patient looked like in a prior exam to determine if change has occurred over time is almost impossible.

2. Test Results are Highly Subjective

H-pattern or Fix and Follow tests are gross motility tests resulting in a dichotomous “normal” or “non-normal” result. There is no measurement quantifying eye deviation in these tests. If the doctor was to conduct a full exam, using prisms, at each position of gaze, for the traditional three repetitions, for both the left and right eye, then this would quantify the deviations of gaze. Very few doctors conduct such exams. They are extremely time intensive. Some doctors conduct a central gaze cover test which takes less time but also provides less information as 8 of the 9 points of gaze are not examined.

“As a health care provider, I know that approximately 30% of my patients have binocular vision disorders. However, I am not able to test for them and the RightEye Sensorimotor product allows me to effectively test and bill.”
Dr. Ken Kopolow, OD, Kopolow Girisgen Doctors of Optometry

3. Inconsistent Interpretation of Results

When we asked the question of several veteran doctors with over 25 years in practice regarding: How do you interpret the results from a cover test:

Doctor 1 response: “Me personally, I flag all eso posture and consider plano to 6xp normal. All at near.”
Doctor 2 response: “I have always simply looked for any movement on alternating cover test to determine something other than orthophoria.”
Doctor 3 response: “At near,…If symptoms are present and the patient is greater than 2+ eso, this is abnormal, and there should be corresponding symptoms.”

Clearly the challenge here is that each doctor, interprets “normal” and “not normal” very differently. Yet, with different interpretations a patient could go to one doctor and be “normal” and the next and be “not normal.” Consistency in result interpretation is a systemic issue.

4. Time-Consuming Exam Impacts Practice Patient Flow

As previously mentioned, conducting a full 9 Cardinal Points Gaze Test, using prisms, at each position of gaze, for the traditional three repetitions, for both the left and right eye, is extremely time consuming. Completing the full exam is anywhere between 30-60 minutes. This impacts the clinical flow of the office. Busy offices conducting basic exams, refraction, and sell eyeglasses do not have time for the doctor to do a comprehensive exam.

Because the exam is long and it impacts the practice flow, it is less likely to be conducted. This has a follow-on effect, in that the practice of conducting the exam is reduced. Without practice, the doctor becomes less willing to conduct the exam. Hence, they either refer patients or simply do not include the exam in their practice.

5. Uncertainly Around Exam Process, Follow Up, Reimbursement

Many times, eye care providers are uncertain on the correct process to administer both the two-step basic exam and complete exam. They are unsure if the patient can be seen on the same day for the basic and full exam. They are unsure what constitutes a basic exam and what should be in the complete exam. Doctors have questions on who is eligible to conduct the exam, and if they need to be present when the exam is conducted.

If a doctor conducts the exam, and finds an issue, what do they do next? Some doctors may know what the patient needs to have happen but are not suited to deliver the solution and therefore they refer the patient to a more suitable practice. However, this is not ideal for the practice as they “lose” the patient. Some doctors may not be sure of all the options for the patient and therefore need some further guidance on what the next steps should be.

Once an exam is conducted doctors can have reservations about how to correctly document the results in the patient’s medical record, and how to use those results for reimbursement.

“Some significant and life altering visual concerns are not corrected simply with glasses or contact lenses alone. The RightEye Sensorimotor screener and full-length exam has been a game changer in allowing everyday Optometrists to expand their scope of care and meet the visual needs of these patients.”
Dr. Keith Smithson, OD, Northern Virginia Doctors of Optometry

Eye care providers are extremely busy seeing and helping their patients. For these reasons and more, the process of learning and figuring it out when day-to-day reality is that the doctor is seeing patients back-to-back. It becomes too much and therefore, even with the best of intentions, it is “left behind.”

Due to these challenges, many doctors do not perform full sensorimotor exams. At the same time, these doctors are aware they may be missing some key visual issues with their patients, and as health care providers, they are driven to help their patients. Doctors are looking for solutions to solves these challenges.

RightEye provides the solution for all of these concerns with our automated RightEye Sensorimotor system, which quickly identifies Binocular Vision Disorders. Eye care providers can now provide greater care to untreated patients and increase their per-patient revenue without disrupting the current patient flow. It’s fast, easy to use, objective, accurate, insurance reimbursable, profitable, zero billable hours.

The revolutionary RightEye Sensorimotor system is powered by advanced eye-tracking technology. The built-in automated screener and comprehensive exam offers ECPs a vast improvement over time-consuming, manual, and subjective sensorimotor tests. Contact us at sales@righteye.com for a no-obligation system demo or pricing details.