Binocular fusion disorders impair basic visual processing

In an era of increasing screen consumption, the requirement for binocular vision is demanding, leading to the emergence of syndromes such as the computer vision syndrome (CVS) or visual discomfort reported by virtual reality (VR) users. Heterophoria (phoria) is a latent eye misalignment (with a prevalence up to 35%) that appears in conditions that disrupt binocular vision and may affect the quality of binocular fusion. Collinear facilitation (CF), the mechanism for grouping contour elements, is a process that reveals lateral interactions by improving the visibility of a target by flankers placed collinearly. An abnormal pattern of CF has been observed in strabismic amblyopia. We hypothesize that phoria may affect CF in the horizontal meridian (HM) due to latent eye misalignment and its impact on binocular fusion. Fully corrected participants (phoria group and controls) completed a standard CF experiment for horizontal and vertical meridians during binocular and monocular viewing. Phoric observers exhibited (1) an asymmetry and an abnormal pattern of CF only for the HM, during both monocular and binocular viewing, (2) poor binocular summation between the monocular inputs, and (3) no binocular advantage of the CF. Phoria affects the CF in a way that is reminiscent of meridional amblyopia without being attributed to abnormal refraction. The abnormal pattern of CF in monocular viewing suggests that phoria could be a binocular developmental disorder that affects monocular spatial interactions. We suggest that the results could contribute to explain the visual discomfort experienced with VR users or symptoms when presenting CVS.