The College of Optometrists

When would you not attempt to binocularly balance a patient under 60 years old? Obviously the patient needs to be binocular and so you would not do it on someone with a squint, but what about unilateral amblyopia? If there was a big differnce in acuities, the better eye would be dominant and so there would be no need to balance. However, what if the difference was only a few lines, would it be worth doing it then? I have read that you don't do it on people with unequal acuities but I thought that the whole point is that we are balancing accommodation not acuities?

if the VA is 6/12 or better I always have a go at balancing

unequal acuities may also cause problems with blurring the dominant eye and this may cause the px to feel uncomfortable (especially if they are younger - under 40?). I would probably restrict it to 6/9 or better myself. at pqe stage you may want to keep things as simmple as possible and restrict yourself to acuities within one line of each other - reducing the likelyhood of problems.

remember if balancing pt with unequal acuity, to check that better eye is blurred back sufficiently. This may require a higher plus power than you normally use.

hear-hear!