A longitudinal study of acuity and phoria among submariners. SMRL Rep No 481.
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Adolescent↗
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Binocular suppression scotoma: its role in phorias and intermittent tropias.
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Adolescent↗
Relationship between refractive error, phoria, and interpupillary distance in 500 patients.
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Humans↗
Clinical findings before the onset of myopia in youth: 3. Heterophoria.
BACKGROUND: Some contemporary theories of the etiology of youth onset myopia suggest differences in accommodation and convergence function. Previous studies have related esophoria to various aspects of myopia development. This paper examines whether differences in phorias exist before the onset of myopia. METHODS: A cohort of initially emmetropic children had eye and vision examinations at 6-month intervals for a period of 3 years. Dissociated phorias were measured by the von Graefe method. These prospective data were analyzed by: (1) comparing phorias in children who became myopic to those in children who remained emmetropic; (2) determination of sensitivity and specificity of phorias to distinguish between children who became myopic and those who did not; and (3) determining the change in phorias with time. These same analyses were also performed as additional analyses of some previously published retrospective private practice data. RESULTS: Distance phorias were not significantly different in the became-myopic and remained-emmetropic group by the Mann Whitney U test in either the private practice data or the prospective data. The near phoria was more convergent in the became-myopic group than in the remained-emmetropic group in the private practice data (p < 0.02 by Mann Whitney U test). In the prospective data there were proportionately more children who became myopic outside the near phoria range of 3 delta exo to 1 delta eso (p < 0.05 by chi 2 test). In both data sets the near phoria showed an eso shift with time in the children who became myopic, beginning before and continuing after the onset of myopia. The children in the remained-emmetropic groups did not show eso shifts in near phoria. CONCLUSIONS: A near phoria which is not close to orthophoria appears to be a risk factor for youth onset myopia, but sensitivity and specificity were not as high as those for other variables such as corneal power, axial length to corneal radius ratio, positive relative accommodation (PRA), and midpoint of the near fusional vergence range. The onset of myopia is associated with an eso (convergent) shift in the near phoria.
Child↗
Optically-induced changes in tonic vergence and AC/A ratio in normal monkeys and monkeys with lesions of the flocculus and ventral paraflocculus.
Monkeys wore either base-out prisms to promote changes in tonic vergence or periscopic spectacles to promote changes in the coupling between accommodation and vergence. Eye movements were recorded using the magnetic search coil technique and the monkeys were rewarded for accurate fixation. Two normal monkeys and two monkeys which had previously received lesions of the flocculus and ventral paraflocculus were studied. After 30 min of prism viewing the two normal monkeys had elevated phoria--increased by approximately 50% of the prism stimulus. The two lesioned monkeys also had phoria increases of a similar size after prism viewing. The effect of duration of prism viewing on the magnitude and time course of phoria elevation was studied in one normal monkey. The initial magnitude of phoria elevation and the time constant of relaxation of phoria both increased as the duration of prism exposure varied from 5 s to 30 min. Initial phoria increased approximately in proportion to the logarithm of duration of prism exposure whereas the time constant of phoria relaxation increased linearly with duration. In the same normal monkey it was shown that increasing vergence by means of accommodative-vergence did not induce phoria changes. The effect of periscopic spectacle viewing was studied in all four monkeys. After 30 min of periscopic spectacle viewing all four monkeys had a higher AC/A ratio. The magnitude of the changes was (paradoxically) greater in the two lesioned monkeys than in the one normal monkey studied fully.(ABSTRACT TRUNCATED AT 250 WORDS)
Accommodation, Ocular↗
Directionally selective short-term nonconjugate adaptation of vertical pursuits.
We investigated the contribution of fixation phoria and dynamic processes to short term (1 hr) nonconjugate adaptation of vertical pursuits. Unequal aftereffects were observed in vertical phoria measured during stationary gaze and during pursuits (static fixation and pursuit phorias) demonstrating direction-specific aftereffects of pursuit phoria that were not evident in measures of fixation phoria. A linear model describes the combination of fixation phoria and three dynamic direction-specific components which include a gain component that determines nonconjugate velocity, a phase component that determines the relative position of binocular pursuits, and a small position specific pursuit phoria adjustment process. Larger position-specific variations of fixation phoria appear to compensate for inappropriate or incomplete adaptive changes produced by two of the dynamic mechanisms which are not position specific.
Adaptation, Ocular↗
Journal of experimental psychology: human perception and performance.
We examined the nonveridicality of visual direction produced by monocular viewing. In Experiment 1, 19 subjects pointed to a small light and moved a small light to their subjective median plane. The extent of constant error under monocular and binocular viewing conditions differed in both tasks (p less than .001). The monocular-binocular difference was larger when the viewing distance was 25 cm than when it was 50 cm (p less than .01). Also, correlations between phoria and monocular-binocular differences ranged from .58 to .77, depending on viewing distances and tasks. The effects of phoria within the context of Hering's .001). The monocular-binocular difference was larger when the viewing distance was 25 cm than when it was 50 cm (p less than .01). Also, correlations between phoria and monocular-binocular differences ranged from .58 to .77, depending on viewing distances and tasks. The effects of phoria within the context of Hering's .001). The monocular-binocular difference was larger when the viewing distance was 25 cm than when it was 50 cm (p less than .01). Also, correlations between phoria and monocular-binocular differences ranged from .58 to .77, depending on viewing distances and tasks. The effects of phoria within the context of Hering's principle of visual direction can account for these results. In Experiment 2, the same subjects adapted to phoria-induced error by placing a finger over a monocularly viewed target. The difference in their pointing responses before and after the task were reliable (p less than .005), and the correlations between phoria and the pre- to posttest differences were .45 and .77, depending on the number of adaptation trials. We argue that all monocular experiments dealing with visual direction should control for these effects.
Discrimination, Psychological↗
The effect of lid elevation on the cross-cover test.
OBJECTIVE: To discern the effect of manual lid elevation on muscle balance using the cross-cover test. MATERIALS AND METHODS: One hundred consecutive patients who were orthophoric in all fields of gaze were prospectively studied. A repeat cross-cover test was performed with the eyes looking down and to either side while pulling the lid ipsilateral to the abducting eye up and to either side. The presence and type of any phoria was noted. RESULTS: Eighty-four percent of patients and 76% of eyes developed a phoria with lifting a lid. Vertical phorias developed in 79 patients and 136 eyes, whereas horizontal phorias were seen in 51 patients and 83 eyes. In all but one case, the vertical deviation was a hyperphoria ipsilateral to the elevated lid. Horizontal deviations were esophoric in 63 eyes of 39 subjects. Induced phorias were most commonly symmetric from side to side. CONCLUSIONS: Lifting the lid produces an iatrogenic phoria that mimics a skew or IV nerve paresis. We hypothesize that stretching the lid causes traction on the levator-superior rectus complex, thereby increasing its tone. Although it makes testing more difficult, we recommend that the lids not be manipulated while performing phoria testing.
Diagnostic Techniques, Ophthalmological↗
Comparison of near heterophoria tests under varying conditions on an adult sample.
PURPOSE: This study compared the near phoria measurement using the Bernell muscle balance card with and without prism neutralization, using both trial frame and phoropter correction, and compared with the conventional Maddox rod method. METHODS: Forty young normal Chinese adults had their near phoria measured with trial frame correction using the conventional muscle balance card method (method 1). Any deviation was compensated with a prism bar as an alternative approach (method 2). The conventional Maddox rod method (method 3) was also carried out for comparison. These three methods were repeated with phoropter correction and considered as methods 4, 5 and 6. RESULTS: The phorias obtained from these six methods were not significantly different from each other (repeated measures anova, p > 0.05). More than half of the subjects were exophoric. Although the difference in phoria was not significant, phoria measurement using phoropter correction yielded a greater coefficient of variation. CONCLUSIONS: Near phoria measurement using the muscle balance card conducted with trial frame correction was less variable, and was also more natural and similar to a real reading situation. The use of prism for compensation did not affect the phoria results. Exophoria seems to be more common than esophoria in young Chinese adults.
Adult↗
An adaptable association between vertical and horizontal vergence.
Vertical phoria (vergence error under monocular viewing conditions) can be trained to vary with conjugate eye position. The adaptive response controls the vertical alignment of the two eyes in the absence of binocular disparity and is used to compensate for binocular changes of the oculomotor system induced by developmental and environmental factors. Vertical phoria was associated with horizontal disparity vergence by adapting vertical vergence to two vertically disparate targets separated along the depth axis. This association was primarily dependent on the horizontal vergence as opposed to monocular eye position or binocular conjugate eye position. Following this adapted association with horizontal disparity vergence, vertical phoria aftereffects were also evoked by accommodative vergence. Previous reports have demonstrated an adapted association between vertical phoria and conjugate eye position. The current report examines the difference in the vertical phoria resulting from adaptation to vertically disparate targets separated along either the vertical axis or depth axis. The amplitude of the vertical vergence aftereffect was approximately 4 times greater for targets separated along the depth axis than in the vertical meridian. The association between vertical phoria with conjugate eye position and horizontal vergence is proposed to result from a cross-coupling of vertical vergence with supranuclear regions that control conjugate and horizontal vergence eye movements. A selective interaction would enable the oculomotor system to correct disturbances in specific supranuclear regions as they interface with vertical vergence.
Accommodation, Ocular↗
Binocular vision without visual stress.
The use of changes in fixation disparity, the associated phoria, and the dissociated phoria in assessing the degree of visual stress requires that we know the effect of vision under close working conditions (40 cm) on these parameters. The authors have previously reported that reading under the stress of abnormally low illumination, or at too close a working distance (20 cm), increases fixation disparity and associated phoria and is associated with symptoms and visual discomfort. The current study shows that reading at photopic levels of illumination and at a working distance of 40 cm does not change the magnitudes of fixation disparity and associated phoria. Reading under these conditions is not accompanied by an onset of symptoms or visual discomfort. This result indicates that changes in fixation disparity and associated phoria are a product of visual stress and are not produced by reading itself.
Adolescent↗
Inter-examiner repeatability of heterophoria tests.
Relatively few studies have reported on the repeatability of heterophoria (phoria) measurement procedures. The purpose of this study was to assess the inter-examiner repeatability of seven clinical tests of phoria measurement, using correlational and mean difference analyses. Two experienced optometrists performed each of the 7 phoria tests on 72 healthy adult subjects. Subjects ranged in age from 22 to 40 years, had visual acuity correctable to 20/20 in each eye, had no strabismus or amblyopia, and had normal eye health. The seven phoria tests used were: (1) the estimated cover test, (2) the prism-neutralized objective cover test, (3) the prism-neutralized cover test with subjective reporting of target movement, (4) the von Graefe phorometry with continuous target presentation, (5) the von Graefe phorometry with flashed target presentation, (6) the Thorington method, and (7) the modified Thorington method. All tests were performed in the same way by both examiners in random sequence, using standard clinical procedures. Inter-examiner correlations were determined for each test, as well as the mean and standard deviation of the differences between each examiner measurement (in prism diopters) on each subject. The modified Thorington method had the smallest mean difference and standard deviation of all tests and, thus, may be considered the most repeatable. This test also had the highest inter-examiner correlation. The prism-neutralized cover test with subjective reporting of target movement had the second highest correlation and the second lowest 95% limits of agreement, but had the largest mean difference of all tests. von Graefe phorometry methods were the least repeatable of the phoria tests.
Adult↗
A cross-coupling model of vertical vergence adaptation.
Vertical disparity vergence aligns the two eyes in response to vertical misalignment (disparity) of the two ocular images. An adaptive response to vertical disparity vergence is demonstrated by the continuation of vertical vergence when one eye is occluded. The adaptive response is quantified by vertical phoria, the eye alignment error during monocular viewing. Vertical phoria can be differentially adapted to vertical disparities of opposite sign located at two positions along the horizontal or vertical head-referenced axes. Vertical phoria aftereffects vary in amplitude as the eyes move from one adapted direction of gaze to another along the adaptation axis. A cross-coupling model was developed to account for the spatial variations of vertical phoria aftereffects. The model is constrained according to both single cell recordings of eye position sensitive neurons, and eye position measurements during and following adaptation. The vertical phoria is computed by scaling the activities of eye position sensitive neurons and converting the scaled activities into a vertical vergence signal. The three components of the model are: neural activities associated with conjugate eye position, cross-coupling weights to scale the activities, and vertical vergence transducers to convert the weighted activities to vertical vergence. The model provides a biologically plausible mechanism for vertical vergence adaptation.
Adaptation, Physiological↗
Heterophoria: a vergence adaptive position.
Previous experiments have shown that as the adaptive change becomes more complete with prolonged wear of a prism, the adaptive decay during monocular occlusion (MO) becomes slower; at the same time, adaptation to a further prism disparity becomes faster. If phoria is an adapted position of the oculomotor system then, as with prism adaptation, it should demonstrate an adaptive decay during MO. The rate of this decay should be inversely related to the rate of adaptation to a prism. In the first part of the paper, changes in the horizontal and vertical phorias were demonstrated at distance and near during 4 hr of MO. In the second part, adaptation to various prism disparities (horizontal and vertical) was monitored. The rates of adaptation were found to be inversely related to the rates of phoria decay during MO. The phoria position is, therefore, an adapted position of the vergence system.
Accommodation, Ocular↗
Test-retest reliability of the Saladin card.
BACKGROUND: Test-retest reliability is a measure of the confidence that results will be identical when the same patient is measured with an instrument in the same manner on more than one occasion. METHOD: Using the Saladin Near Point Balance Card--an instrument designed to test various near visual findings, including visual acuity, phorias, AC/A ratios, dynamic retinoscopy, fixation disparity, associated phorias, fixation disparity curves, as well as accommodative and vergence facilities--28 first- and second-year optometry students were evaluated on two occasions by one clinician, with the tests separated by approximately two weeks. Subjects were required to demonstrate 20/20 distance visual acuity and at least 100 sec of arc stereopsis. A total of 38 findings were compared, which included near horizontal and vertical phorias, associated phoria, and fixation disparity curves. Twenty-two findings were performed through the subjects' habitual prescription and the remaining findings were taken through the lens indicated by MEM retinoscopy. PURPOSE: The purpose of this study was to investigate whether the Saladin Near Point Balance Card had acceptable test-retest reliability. If reliability can be demonstrated, this instrument could be used in clinical situations to diagnose visual departures from normal. RESULTS: All but two of the 38 tests performed demonstrated acceptable test-retest reliability. Coefficients of repeatability and 95% limits of agreement were calculated. The Saladin Near Point Balance Card demonstrated acceptable test-retest reliability. CONCLUSION: Since it is light-weight, portable, easily and quickly administered, and reliable, the Saladin card can be used by clinicians who are performing screenings or examinations in non-clinical situations, such as nursing homes or schools.
Adult↗
Negative vergence training in humans.
Two healthy subjects (male and female, ages 22 and 25 years) spent 50 h over a period of 7 consecutive weeks training the negative vergence system. The training was performed in two 45-min daily sessions, usually immediately before and after the workday. The training was exclusively negative vergence training using devices such as variable vectograms, the aperture rule, the synoptophore, and loose or bar prisms. An extensive examination of the visual systems before, after, and periodically during the training demonstrated that the negative vergences increased at distance by 5.0 delta and at near by 9.1 delta (using hand-held prisms, bar prisms, and the synoptophore). The phorias of both subjects became more exophoric or less esophoric at both distance and near by 3.6 delta (using average of changes on the cover test, von Graefe subjective phoria technique, and the synoptophore). A haploscope equipped with a coincidence optometer showed only small increases in vergence amplitude but confirmed that the lag of accommodation became more stable after the training than it was before. Other testing suggested that the negative relative accommodation, the angle of deviation at both distance and near, positive vergences, the associated phoria, and the slope of the fixation disparity curve changed significantly over the period of training. I conclude that negative vergence training can increase the negative vergence capabilities and also affect the phoria position of the eyes via feed-back into the slow vergence system.
Accommodation, Ocular↗
Comparison of vertical fixation disparities between essential hypertensives and matched normotensives.
Using American Optical Vectographs and a Disparometer, vertical fixation disparities and associated phorias were measured on 19 essential hypertensives and 19 matched normotensives. Subjects were matched on the basis of race, sex, age, use of tobacco, and family history of hypertension. Correlated variance comparisons of the measured associated phorias and fixation disparities, as well as calculated x and y intercepts derived from forced-duction vertical fixation disparity curves were made and a t-test for related measures was used to compare slopes. The x and y intercepts and slope data showed no significant differences between the groups. However, statistically larger measured associated phorias for the hypertensive group were found on all but one test. This suggests a relation between the magnitude of vertical associated phorias and the occurrence of essential hypertension, but the relation found was not of sufficient strength to warrant clinical application.
Adult↗
Relation between distance heterophoria and tonic vergence.
The distance heterophoria was measured using both the von Graefe and Maddox rod clinic procedures under standard reduced illumination conditions and in total darkness. Tonic vergence was measured in total darkness. The phoria measures were more divergent than tonic vergence, with the von Graefe being the more divergent of the two measures. The difference between the phoria and tonic vergence position is believed to be due to accommodative divergence derived from the decrease of accommodation, relative to the tonic level, required to focus the distance phoria target. Equations were derived to predict tonic vergence from the phoria value.
Adult↗