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Paik and Lim: Accommodation and Convergence, Anomalies of Convergence
Original Article
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(12): 1719-1726.

Published online: 17 December 2012

DOI: https://doi.org/10.3341/jkos.2012.53.12.1719

Accommodation and Convergence, Anomalies of Convergence

Hae Jung Paik, MD, PhD1, Hyun Taek Lim, MD2

1Department of Ophthalmology, Gachon University, Gil Medical Center, Incheon, Korea.

2Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Address reprint requests to Hae Jung Paik, MD, PhD. Department of Ophthalmology, Gachon University Gil Medical Center, #21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 405-760, Korea. Tel: 82-32-460-3364, Fax: 82-32-460-3358, hjpaik@gilhospital.com

Received 5 October 2012       Accepted 13 November 2012

Copyright © 2012 The Korean Ophthalmological Society

Abstract

Purpose

Accommodation and convergence, the main factors of near vision complex on near vision associated with miosis are essential ocular movements for binocularity. Therefore, we attempted to find appropriate treatments for anomalies of accommodation and convergence.

Methods

The basic theories and anomalies of accommodation and convergence were reviewed. Various treatment modalities for anomalies of convergence were discussed and treatment guidelines were proposed.

Results

Anomalies of convergence were classified into convergence insufficiency, convergence insufficiency associated with accommodative insufficiency, convergence paralysis, convergence spasm, and convergence excess. Treatment was divided into non-surgical and surgical methods which include not only vision therapy and optical treatment using a prism after cycloplegic refraction, but also rectus muscle surgery.

Conclusions

The choice of effective treatments according to various causes is necessary for anomalies of accommodation and convergence through complete eye examinations. Thus, not only simple refractive error measurement and glasses prescription for best corrected visual acuity are necessary, but also active treatment by fundamental ophthalmic and neurologic evaluation in hospitals.

Keywords: Accommodation, Anomalies of convergence, Convergence, Fundamental ophthalmic examination, Vision therapy

Figures and Tables

Table 1
Normal range of AC/A ratio according to the calculation method
jkos-53-1719-i001

AC/A ratio = accommodative convergence / accommodation ratio.

References

1. Mays LE, Gamlin PD. Neuronal circuitry controlling the near response. Curr Opin Neurobiol. 1995. 5:763–768.
2. Morgan MW Jr. Relationship between accommodation and convergence. AMA Arch Ophthalmol. 1952. 47:745–759.
3. von Noorden GK, Morris J, Edelman P. Efficacy of bifocals in the treatment of accommodative esotropia. Am J Ophthalmol. 1978. 85:830–834.
4. Fry GA. Further experiments on the accommodation convergence relationship. Am J Optom. 1939. 16:325–336.
5. Fry GA, Haines FF. Tait's analysis of the accommodative-convergence relationship. Am J Optom. 1940. 17:383–389.
6. von Noorden GK, Campos EC. Binocular vision and ocular motility : theory and management of strabismus. 2002. 6th ed. St. Louis: CV Mosby;92.
7. Ogle KN, Martens TG, Dyer JA. Oculomotor imbalance in binocular vision and fixation disparity. 1967. Philadelphia: Lea & Febiger;87–88.
8. Thompson DA. Measurements with cover test vs. troposcope. Am Orthopt J. 1952. 2:47–52.
9. Jackson JH, Arnoldi K. The gradient AC/A ratio: what's really normal? Am Orthopt J. 2004. 54:125–132.
10. Alpern M, Kincaid WM, Lubeck MJ. Vergence and accommodation. III. Proposed definitions of the AC/A ratios. Am J Ophthalmol. 1959. 48:141–148.
11. von Noorden GK, Campos EC. Binocular vision and ocular motility : theory and management of strabismus. 2002. 6th ed. St. Louis: CV Mosby;500–507.
12. von Graefe A. Über musculäe Asthenopie. Graefes Arch Clin Exp Ophthalmol. 1862. 8:314–367.
13. Nemet P, Stolovitch C. Biased resection of the medial recti: A new surgical approach to convergence insufficiency. Binocul Vis Strabismus Q. 1990. 4:213.
14. von Graefe A. Über Myopie in distans nebst Betrachtungen Über Sehen jenseits der Grenzen unserer Accommodation. Graefes Arch Clin Exp Ophthalmol. 1862. 8:314–367.
15. Duke-Elder S. System of Ophthalmology: Ocular Motility and Strabismus. 1973. v. 6. St. Louis: CV Mosby;570.
16. Grisham JD. Visual therapy results for convergence insufficiency: a literature review. Am J Optom Physiol Opt. 1988. 65:448–454.
17. von Noorden GK. Resection of both medial rectus muscles in organic convergence insufficiency. Am J Ophthalmol. 1976. 81:223–226.
18. Jampolsky A. Ocular divergence mechanisms. Trans Am Ophthalmol Soc. 1970. 68:730–822.
19. Duane A. Anomalies of the accommodation clinically considered. Trans Am Ophthalmol Soc. 1915. 14(Pt 1):386–402.
20. Brown HW. Haik GM, editor. Strabismus in the adult. Symposium of the New Orleans Academy of Ophthalmology. 1950. St. Louis: Mosby-Year Book;351.
21. Parinaud H. Clinical nerveuse: Paralysie des mouvements associës des yeux. Arch Neurol (Paris). 1883. 5:145.
22. Walsh FB, Hoyt WF. Clinical neuro-ophthalmology. 1969. 3rd ed. Baltimore: Williams & Wilkins;1208.
23. Gilad E, Biger Y. Paralysis of convergence caused by mushroom poisoning. Am J Ophthalmol. 1986. 102:124–125.
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