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Accommodation & Convergence Disorders

Accommodation & Convergence Disorders. Ralph P. Garzia, O.D. College of Optometry 9/18/08. Accommodation Disorders. Insufficiency (ill-sustained) Excess Infacility Inconsistency. Accommodation Disorders. Insufficiency (ill-sustained) Excess Infacility Inconsistency. Blurred vision

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Accommodation & Convergence Disorders

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  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

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