Contact Us Today! (208) 377-8899

Binocular Vision / Eye Teaming

Binocular vision describes the process by which the brain integrates the information from the two eyes to form clear, comfortable, binocular single vision. Binocular vision is an important aspect of the visual system as binocular vision dysfunction can cause a number of symptoms, including: double vision, headaches, eyestrain, difficulties with balance and mobility, and difficulties with reading or computer use.


Binocular vision dysfunction, such as convergence insufficiency, can be present from birth and negatively impact a child's ability to perform visual tasks in the classroom. Children with amblyopia (lazy eye) or strabismus (eye turn) have binocular vision dysfunction and are not able to use both eyes effectively as a team. Adults can also experience binocular vision dysfunction as the result of a concussion or other form of traumatic brain injury, a stroke, or an eye turn that results from a nerve palsy (such as can occur with diabetes). For those with acquired brain injury, binocular vision dysfunction is part of a constellation of conditions referred to as 'Post Trauma Vision Syndrome'.


In order to properly treat binocular vision dysfunction it must first be identified. Binocular vision dysfunction is diagnosed by a neuro-optometrist, such as Dr. Ryan C. Johnson, during a Binocular Vision Assessment. During this assessment several aspects of your vision will be evaluate and the most appropriate course of treatment will be prescribed.


Call to schedule your Binocular Vision Assessment  |  No referral needed

Binocular Vision Assessment

During a binocular vision assessment, our doctor will evaluate the aspects of your vision that most others don't. A thorough binocular vision assessment should consist of 2 major components: 1) Visual skills, or the mechanics of how efficiently you are able to use your eyes, 2) Visual perceptual, or how your brain interprets the visual information it receives from the eyes.


VISUAL SKILLS: The following visual skills should be evaluated during your binocular vision assessment

  • Accommodation (eye focusing skills): The strength, flexibility, and accuracy of the eye focusing system should be evaluated. Deficits in accommodation will result in blurry vision during near work, blurry vision when transitioning from near to distance tasks (such as copying notes from the board in school), and eye strain or fatigue. Our doctors are able to assess every aspect of the accommodative system and compare your results against age-based norms to determine the most appropriate treatment plan.
  • Depth Perception (3D): Often called “3D vision”, depth perception is dependent on the ability to use both eyes together at the highest level. Deficiencies in depth perception can result in a lack of 3D vision or headaches and eye strain during 3D movies. There are multiple types of depth perception, all of which are assessed by our doctors during a binocular vision assessment.
  • Fusion: Fusion is the ability to use both eyes together. When an individual has a fusion deficit, the will either see double or the brain will adapt and suppress (or ignore) one of the eyes. This can happen 100% of the time or intermittently, depending on the cause of fusion deficit. Our doctor will evaluate your ability to use both eyes together in a variety of settings (for example at near versus distance) to determine if any fusion deficits are present. Depending on the cause of the fusion deficit, the doctor will design a treatment plan to eliminate the double vision and improve your ability to use both eyes together.
  • Ocular Motility (eye movements): The quality of your eye movements is related to the neural connections to the brain as well as the integrity of the eye muscles themselves. When performed in the right hands, eye movements can be used to determine the presence of central nervous system dysfunction (such as that arising from tumors, inflammation, or neurologic conditions). Additionally, ocular motility testing allows our doctors to evaluate eye tracking skills that are used during reading.
  • Ocular Posture (resting position): Ocular posture, or the resting position of the two eyes, is evaluated to determine the presence or absence of strabismus(eye turn). Eye position is also related to headaches, eyestrain, fatigue, and double vision. Assessment of ocular posture allows our doctors to determine the cause of any abnormal resting position and determine the most appropriate treatment plan for you.
  • Presence of Conditions That Will Affect Binocular Vision Functioning: There are several conditions that affect binocular vision functioning. Some of these conditions are ocular (such as amblyopia, strabismus, cataracts, glaucoma, and several other ocular diseases) while others are systemic (such as diabetes, stroke, thyroid dysfunction, autism, and cerebral palsy to name a few). Our doctors work with your other health care providers to ensure that both you and your eyes are cared for.
  • Vergence (Eye teaming): The strength and flexibility of the eye teaming system should be evaluated. Deficits in eye teaming will result in double vision, eyestrain, fatigue, headaches, or dizziness. Our doctors will assess all aspects of eye teaming and compare them to age-based norms to determine the most appropriate treatment plan to improve your eye teaming abilities.
  • Visual Acuity: How clearly you see is the foundation of a strong binocular vision system. If you do not see equally out of each eye it has the potential to affect eye teaming. Should you not see 20/20 out of each eye, our doctors will determine the cause of your reduced vision and determine the effect it has had on your binocular vision.


PERCEPTUAL SKILLS: The following perceptual skills should be evaluated during your binocular vision assessment

  • Processing Speed: This is a measure of how quickly your process visual information. Deficiencies in processing speed will result in delayed reaction time (such as during driving or sports) or difficulties finishing timed tests, class assignments, or homework in a timely manner.
  • Spatial Awareness/Planning: This perceptual skill allows one to know right from left,orient themselves in space, and determine proper orientation of letters and numbers. Difficulties with spatial awareness and planning results in letter or number reversals, sloppy handwriting, misalignment of numbers in math problems, and other challenges with judging distances or directions.
  • Visual Integration: The integration of visual information with the other senses is critical. Making sense of your world relies on all of the senses working harmoniously. The integration of visual and fine motor skills is important for handwriting just as the integration of the auditory and visual systems is important for learning in the classroom. Advanced Vision Therapy Center works with other professionals (such as occupational therapists and speech/language pathologists)
  • Visual Perception: This group of skills includes visual discrimination (determining likeness), spatial relations (determining differences), form constancy (determining sameness even when changed in size or orientation), visual memory, visual sequential memory, figure-ground (extracting valuable information from the background), and visual closure (ability to put the pieces together to form the whole). These perceptual skills are essential for academic success and learning.
  • Working Memory: This perceptual skill is critical for the acquisition of new material and concepts. Deficits in working memory can result in challenges learning new concepts; such as spelling. Those who struggle with working memory often find that no matter how hard (or how long) they try, the results are just not there.


Since 1991, our team of trained specialists have been providing diagnosis and treatment of binocular eye teaming problems.  In cooperation with Advanced Vision Therapy Center, we offer assessment and treatment of binocular vision dysfunction.

Ryan C. Johnson, OD, FAAO: Neuro-Optometrist

A native of Boise, Dr. Johnson graduated from Boise State University with a bachelor's of science in kinesiology. Dr. Johnson graduated from Southern California College of Optometry before pursuing a residency in binocular vision, vision therapy, and neuro-optometry at the University of California, Berkeley.

Dr. Johnson is Idaho's first residency trained optometrist in neuro-optometry, binocular vision and vision therapy. With his residency training, Dr. Johnson's clinical experience and expertise is in the areas of strabismus, amblyopia, binocular vision dysfunction, acquired brain injury, vision therapy, vision rehabilitation, and the visual system as it relates to brain function.

Dr. Johnson also combines his knowledge of exercise science from his undergraduate work with his understanding of the visual system to provide sports vision training to enhance visual performance for athletes of all ability levels - bringing vision rehabilitation and sports vision training to Idaho.

Dr. Johnson is a fellow of the American Academy of Optometry (FAAO) as well as a member of the American Optometric Association & Idaho Optometric Physicians. He also serves as clinical director at Advanced Vision Therapy Center.

Accepting new patients. No referral necessary.


Schedule your appointment with Dr. Ryan C. Johnson or call us at 208.377.8899.