Abstract Introduction The purpose of this study is first to describe a simple test for studying the relationship between the stimulus to accommodation and the accommodative convergence at a fixed near distance, and second to illustrate by case reports the value of graphic analyses of this relationship in classifying oculomotor anomalies and in evaluating various forms of therapy. Previous Investigations The ophthalmological literature of 50 or more years ago includes papers describing the use of graphs to depict relationships between convergence and accommodation and amplitudes of relative fusional convergence and divergence. This early work has been reviewed by Morgan.1In recent years two simpler procedures have been used, particularly in research laboratories of physiological optics, to study the changes in convergence induced by changes in accommodation. In most cases only normal subjects without ocular symptoms have been studied. The two procedures may be designated as the variable-distance method and the References 1. For an exact determination of the convergence the subject's interpupillary distance must be known. The interpupillary distance in cm. divided by the fixation distance in meters equals the prism diopters of convergence required for orthophoria at this distance. For this subject orthophoria at 33 cm. corresponds to 6.4 times 3 or 19.2Δ of convergence. 2. If the manifest hyperopia is not fully corrected the patient will accept spherical power greater than +3 without noting blurring of test details at 33 cm. If blurring occurs with spherical powers less than +3, overcorrection of a hyperopia or under-correction of a myopia is indicated. 3. Morgan, M. W., Jr.: Relationship Between Accommodation and Convergence , A.M.A. Arch. Ophth. 47:745-759, 1952.Crossref 4. Morgan, M. W., Jr.: A Comparison of Clinical Methods of Measuring Accommodative-Convergence , Am. J. Optom , Monograph 102, 1950, pp. 385-396. 5. Emmes, A. B.: A Statistical Analysis of the Accommodative-Convergence Gradient , Am. J. Optom. 26:474-482, 1949.Crossref 6. Manas, L., and Shulman, P.: The Variation in the Accommodative-Convergence Accommodation (ACA) Ratio upon Periodic Retesting , Am. J. Optom. 31:385-396, 1954.Crossref 7. Tait, E. J.: Accommodative Convergence , Am. J. Ophth. 34:1093-1107, 1951. 8. Alpern, M.: Testing Distance Effect on Phoria Measurement at Various Accommodation Levels , A.M.A. Arch. Ophth. 54:906-915, 1955.Crossref 9. Martens, T. G., and Ogle, K. N.: Observations on Accommodative Convergence , Am. J. Ophth. 47:455-463 (Jan., (Pt. 2) ) 1959. 10. Hofstetter, H. W.: Accommodative Convergence in Identical Twins , Am. J. Optom , Monograph 55, 1948. 11. Westheimer, G.: The Relationship Between Accommodation and Accommodative Convergence , Am. J. Optom. 32:206-212, 1955.Crossref 12. Flom, M. C.: Variations in Convergence and Accommodation Induced by Successive Spherical Lens Additions with Distance Fixation: An Investigation , Am. J. Optom. 32:111-136, 1955.Crossref 13. Christoferson, K. W., and Ogle, K. N.: The Effect of Homatropine on the Accommodation-Convergence Association , A.M.A. Arch. Ophth. 55:779-791, 1956.Crossref 14. Sabin, F. C., and Ogle, K. N.: Accommodation-Convergence Association Experiments with Phenylephrine, Pilocarpine, and Physostigmine , A.M.A. Arch. Ophth. 59:324-332, 1958. 15. Malbran, E. S., and Norbis, A.: Le D.F.P. dans le traitement du strabisme convergent , Ann. ocul. 188:720-733, 1955. 16. Knapp, P., and Capobianco, N.: Use of Miotics in Esotropia , Amer. Orthoptic J. 6:40-46, 1956. 17. Costenbader, F. D.: Accommodative Esotropia: Principles of Treatment , Tr. Am. Acad. Ophth. 61:390-394, 1957. 18. Scobee, R. G.: The Oculorotary Muscles , St. Louis, C. V. Mosby Company, 1947, p. 351.
A.M.A. Archives of Ophthalmology – American Medical Association
Published: Feb 1, 1960
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