Accommodation & Convergence Disorders

1. Accommodation & Convergence Disorders Ralph P. Garzia, O.D. College of Optometry 9/18/08

2. Accommodation Disorders • Insufficiency (ill-sustained) • Excess • Infacility • Inconsistency

3. Accommodation Disorders • Insufficiency (ill-sustained) • Excess • Infacility • Inconsistency

4. Blurred vision Diplopia Headaches Asthenopia Fatigue/sleepiness Delayed clarity on near fixation Reduced - facility Increased lag Reduced amplitude Associated convergence problems CI CE Accommodative Insufficiency (ill-sustained accommodation)

5. Treatment Triad • Lenses • Prism • Vision Therapy

6. Accommodation Disorders • Insufficiency • Excess • Infacility • Inconsistency

7. Blurred vision Diplopia Headaches Asthenopia Fatigue/sleepiness Delayed clarity on distance fixation Reduced + facility Decreased lag Associated convergence problems CE Accommodative Excess

8. Treatment Triad • Lenses • Prism • Vision Therapy

9. Accommodation Disorders • Insufficiency • Excess • Infacility • Inconsistency

10. Blurred vision Diplopia Headaches Asthenopia Fatigue/sleepiness Delayed clarity on distance & near fixation Reduced + & - facility Decreased lag Accommodative Infacility (also called inertia of accommodation)

11. Treatment Triad • Lenses • Prism • Vision Therapy

12. Accommodation Disorders • Insufficiency • Excess • Infacility • Inconsistency

13. Blurred vision Diplopia Headaches Asthenopia Fatigue/sleepiness whatever? Inconsistent Accommodation

14. Treatment Triad • Lenses • Prism • Vision Therapy

15. Convergence Disorders • Duane-White classification • Distance • Divergence Excess • Divergence Insufficiency • Near • Convergence Excess • Convergence Insufficiency • Distance & Near • Basic eso • Basic exo

16. Convergence Disorders • Duane-White classification • Distance • Divergence Excess • Divergence Insufficiency • Near • Convergence Excess • Convergence Insufficiency • Distance & Near • Basic eso • Basic exo

17. Divergence Excess • Intermittent exotropia @ distance

18. Divergence Insufficiency • Intermittent esotropia @ distance

19. Convergence Disorders • Duane-White classification • Distance • Divergence Excess • Divergence Insufficiency • Near • Convergence Excess • Convergence Insufficiency • Distance & Near • Basic eso • Basic exo

20. Convergence Insufficiency • Receded NPC • Higher exophoria • Reduced PFV (BO) • Reduced NRA • Associated AI

21. Treatment Triad • Lenses • Prism • Vision Therapy

22. Convergence Excess • Higher esophoria • Reduced NFC (BI) • Reduced PRA • Associated AI

23. Treatment Triad • Lenses • Prism • Vision Therapy

24. Convergence Disorders • Duane-White classification • Distance • Divergence Excess • Divergence Insufficiency • Near • Convergence Excess • Convergence Insufficiency • Distance & Near • Basic eso • Basic exo

25. Basic Esophoria • Reduced NFV @ near • Reduced BI @ distance

26. Basic Exophoria • Reduced PFV @ near • Reduced BO range @ distance

27. Association-Interaction Problems

28. Association-Interaction Problems

29. Association-Interaction Problems

30. Association-Interaction Problems

31. Association-Interaction Problems

32. Control Systems Explanations

33. near exo PFV = conv-accom If CA/C ratio high:  reflex accom required to maintain clarity Can’t relax = accommodative excess near exo PFV = conv-accom If CA/C ratio low:  reflex accom required to maintain clarity Can’t accommodate= accommodative insufficiency Convergence Insufficiency (low AC/A)

34. near eso NFV = conv/accom If CA/C ratio high:  reflex accommodation required to maintain clarity Can’t accom = accommodative insufficiency near eso NFV = conv/accom If CA/C ratio low:  reflex accommodation required to maintain clarity Can’t relax accom = accommodative excess Convergence Excess(high AC/A)

35. Esophoria Flowchart

36. Exophoria Flowchart

37. No significant phoria