Convergence accommodation in orthoptic practice

Horwood, A. British & Irish Orthoptic Journal. (2016); 13; 2-8 ISSN 1743-9868,13, 2-8

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• This is a review article for clinical orthoptists, ophthalmologists and optometrists outlining our work on the relationships between accommodation and convergence
• The role of convergence to drive accommodation is often more important that AC/A linkages

Aim

Orthoptists are familiar with AC/A ratios and the concept that accommodation drives convergence, but the reverse relationship, that of the accommodation associated with convergence, is rarely considered.

Methods

This article reviews published evidence from our laboratory which has investigated the drives to both vergence and accommodation. All studies involved a method by which accommodation and vergence were measured concurrently and objectively to a range of visual stimuli which manipulate blur, disparity and proximal/looming cues in different combinations.

Results

Results are summarised for both typical and atypical participants, and over development between birth and adulthood.

Conclusions

For the majority of typical children and adults, as well as patients with most heterophorias and intermittent exotropia, disparity is the main cue to both vergence and accommodation. Thus the convergence / accommodation relationship is more influential than that of accommodative vergence. Differences in ‘style’ of near cue use may be a more useful way to think about responses to stimuli moving in depth, and their consequences for orthoptic patients, than either AC/A or CA/C ratios. The implications of a strong role for vergence accommodation in orthoptic practice are considered.