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PubMed1982

Proximal and accommodative convergence and age.

The authors have estimated the phoria for distant and near fixation in two groups of subject (mean age 27. 5+/- 4.4 and 59.2 +/- 8.2 years). Different accommodative stimuli were induced by adding minus lenses for distant fixation and plus lenses for near fixation. Statistical analysis of the experimental data indicates that, for distant fixation, the value of phoria per unit of accommodative stimulus is significantly lower presbyopic than in nonpresbyopic subject. Also, during near fixation, the accommodative convergence (AC/A ratio) is more reliable in the presbyopic subjects when the accommodative stimulus is progressively reduced. This varying behavior indicates in presbyopic subjects that proximal convergence is of greater relative importance in the determination of the fusion-free position. In nonpresbyopic subjects, accommodative convergence is the more important component.

Accommodation, Ocular↗
PubMed1996

Accommodative vergence is driven by the phasic component of the accommodative controller.

Conflicting opinions exist as to whether the phasic (reflex) component alone or both the phasic and tonic (adaptive) components of the accommodation and vergence systems drive accommodative vergence and vergence accommodation crosslinks. In this study the dissociated phoria to a 2 D target was measured before and after accommodative adaptation to discriminate the two possibilities. Results showed a significant difference in the dark-focus of accommodation pre- and post-near-vision task, indicating that accommodative adaptation had occurred. No significant change occurred in dark-vergence or in the accommodative response to the 2 D target. However, a significant decrease was found in the dissociated phoria presumably because of decreased phasic accommodation and its stimulation of accommodative vergence after the adaptation. This result is consistent with a model in which the accommodative vergence crosslink is driven by phasic accommodation only.

Accommodation, Ocular↗
PubMed2001

Adaptive control of pursuit, vergence and eye torsion in humans: basic and clinical implications.

Recent research from our laboratory has been directed at understanding the range of capabilities for adaptive control of eye movements in normal human subjects. For smooth pursuit, different motor responses to the same sensory stimulus (horizontal target motion) can be learned, stored and gated in or out, according to context (vertical eye position). The dynamic properties of the 'open-loop' portion of horizontal, disparity-driven vergence eye movements are under adaptive control. Eye torsion is also subject to adaptive control, including torsional 'phoria adaptation' and cross-coupling of torsion into the horizontal vestibulo-ocular reflex (VOR). Finally, lesions of the oculomotor vermis in monkeys produce disordered binocular ocular motor function: 'esodeviations' in the absence of disparity cues, and decreased adaptation of the horizontal phoria to a sustained disparity induced by wearing a horizontal prism in front of one eye.

Adaptation, Physiological↗
PubMed2002

The cyclopean eye in vision: the new and old data continue to hit you right between the eyes.

We argue against recent claims by Erkelens and van Ee (Vision Res., in press) and by Erkelens (Vision Res. 40 (2000) 2411) that "the concept of the cyclopean eye is em leader always irrelevant as far as vision is concerned" (p. 1157) [corrected] and that "perceived direction during monocular viewing is based on the signals of the viewing eye only" (p. 2411), respectively. In Experiment 1, we presented a pair of small lights on a visual axis and measured the absolute visual direction of the near light with reference to different parts of the face. The near light appeared in front of the bridge of the nose or very near it, contrary to what was expected from Erkelens and van Ee's claim that monocular stimuli are seen in their correct locations. In Experiment 2, we replicated Erkelens' experiments with measurements of phoria and analyses of eye movements. The results confirmed his finding that the cyclopean illusion occurred rarely in the monocular condition, but our phoria and eye movement data provided the basis for a very different interpretation. Our data show that the oculomotor signal in his particular monocular condition was considerably weaker than in his binocular condition; therefore, the rarity of the monocular cyclopean illusion is not surprising. Moreover, since both claims above are based on an over-generalization of the results of Erkelens' study, neither claim is persuasive.

Adult↗
PubMed1997

Head-position-dependent adaptation of nonconcomitant vertical skew.

Vertical phoria can be trained to vary with either head position or orbital eye position. The present experiments show that subjects can simultaneously adapt their eye-position-specific (nonconcomitant) vertical phorias in different directions at different head positions. Eye-position-dependent and head-position-dependent adaptive pathways, therefore, are not independent. Rather, the adaptation of vertical skew takes into account both eye and head position. In additional experiments, the magnitude of the nonconcomitant adaptive response was shown to be related to otolith output, increasing with head tilt ipsilateral to the tilt position at which training was received and decreasing in the contralateral direction.

Adaptation, Physiological↗
PubMed1995

Palpebral fissure height and downgaze in patients with Graves upper eyelid retraction and congenital blepharoptosis.

PURPOSE: To compare the relation between vertical eyelid fissure height and downgaze in healthy subjects and in patients with Graves upper eyelid retraction and congenital blepharoptosis. METHODS: With a caliper rule, the authors measured the vertical eyelid fissure height of 25 patients with no previous history of eye disease, 34 patients with Graves disease, and 16 patients with congenital blepharoptosis. All measurements were done at the primary position and at four levels of downgaze (10 degrees, 20 degrees, 30 degrees, and 40 degrees). In 13 patients with Graves disease, vertical phoria was quantified with a Maddox rod and prism. RESULTS: The relation between vertical eyelid fissure height and downgaze is linear. The slope was identical for the control subjects and for the patients with Graves disease (b = -1.36) but it was almost zero for the patients with congenital blepharoptosis (b = -0.037). When vertical eyelid fissure height was corrected to arc values, the slope of the relation between vertical eyelid fissure height and downgaze was significantly greater for the patients with Graves disease. Vertical phoria was not related to the amount of Graves upper eyelid retraction. CONCLUSIONS: The data support the hypotheses that upper eyelid retraction secondary to Graves eye disease results from hyperactivity of the levator palpebrae superioris muscle.

Adolescent↗
PubMed1980

[Microtropia - heterophoria].

In 31 cases of microtropia combined with large angle esophoria, prism treatment and surgery to eliminates the phoria component were performed. In 19 cases a stable microsotropia remained after elimination of the phoria component. In 12 cases unstable microtropia was found, i.e., the microtropia disappeared after treatment. In these cases, microtropia may be secondary to the heterophoria. The treatment of the esophoria component in cases of microtropia/esophoria with refraction or bifocal correction, prisms and surgery is as much indicated as in simple esophoria.

Humans↗
PubMed1979

Use of horizontal prism to correct vertical fixation disparity.

By noting the direction of gaze in which the vertical phoria is largest, one can determine where binocular discomfort is likely to be greatest. Treatment of the discomfort is then based upon prescribing horizontal prism for the horizontal phoria. The recommended amount of horizontal prism is that amount which reduces the vertical fixation disparity to zero. Although the fixation disparity can change in different directions of gaze, in most instances, the prescribed amount of horizontal prism is determined in the primary position of gaze.

Adolescent↗
PubMed1982

Graphical analysis of prism adaptation, convergence accommodation, and accommodative convergence.

A new form of graphical case analysis is described which quantifies static interactions between accommodative convergence, convergence accommodation, and prism adaptation. A clinical gradient measure of the CA/C ratio is compared to haploscopic measures to demonstrate the validity of the new clinical technique for measuring convergence accommodation. Graphical and computational methods are illustrated which predict the quantitative interactions between accommodation and convergence that occur after the phoria is partially corrected by lenses or prisms. Complete correction of convergence accommodation errors with spherical lenses or elimination of the stimulus to convergence accommodation by full correction of the associated phoria with prism will simplify the correction of binocular disorders by preventing the complex interactions of accommodative convergence with convergence accommodation. The new form of graphical analysis quantifies the predicted stress upon binocular vision induced by convergence accommodation.

Accommodation, Ocular↗
PubMed1983

Analysis of tonic and accommodative vergence disorders of binocular vision.

Tonic and accommodative vergence disorders of binocular vision are analyzed with separate methods. The center of symmetry and the associated phoria of forced duction fixation disparity curves are two criteria used for prismatic correction of tonic vergence disorders. The associated phoria is corrected physiologically when patients who have tonic disorders are able to develop prism adaptation with orthoptic exercises. Graphical methods are used to analyze accommodative disorders resulting from mutual interactions between accommodation and convergence. Graphic analysis illustrates that patients with high AC/A ratios have greater demands upon fusional divergence than other patients with similar ocular deviations who have normal or low AC/A ratios. Prism adaptation, which has no direct influence upon the open-loop accommodative response, replaces corrective fusional vergence innervation and thereby eliminates the main stimulus to convergence accommodation and its exaggeration of accommodative convergence. Because prism adaptation has a response time of 15 to 30 sec, abnormal accommodative convergence interactions exaggerated by convergence accommodation can be transient in patients with normal prism adaptation. Accommodative convergence disorders in patients who lack prism adaptation are classified as sustained. Orthoptic exercises which develop fast fusional vergence are recommended for the transient disorders and additional exercises to develop prism adaptation are recommended for the sustained disorders of accommodative vergence interactions.

Accommodation, Ocular↗
PubMed1985

An esophoric shift associated with sustained fixation.

Some subjects show a progressive increase in their near phoria, in the direction of more esophoria, when the test is repeated. Eighteen of 100 subjects showed 5 delta or more esophoric shift. This result suggests that similar phoria changes may occur during prolonged intensive nearwork. The results reported are not the same as prism adaptation because the esophoric shift was found with dissociated targets. Autonomic arousal with sympathetic activation associated with heightened attention and concentration is proposed as the mechanism.

Accommodation, Ocular↗
PubMed1987

Clinical method for measuring adaptation of tonic accommodation and vergence accommodation.

Previous work indicates that tonic adapters of accommodation and vergence have indirect effects on accommodative vergence and vergence accommodation and that these crosslink responses interact with one another to produce clear and single vision. Clinical measurements of tonic accommodation, tonic vergence, vergence accommodation (CA/C ratio), and accommodative vergence (AC/A ratio) are therefore of value in determining possible binocular vision abnormalities. Currently, clinical methods are only available for measuring the tonic vergence (phoria) and the AC/A ratio. We have determined a fast and accurate method for evaluating both tonic accommodation (accommodative phoria) and vergence accommodation (CA/C ratio). In both procedures, the loop of accommodation was opened with a 0.2 cpd difference of Gaussian (DOG) target. This target was found to be incapable of stimulating any reflex accommodation, yet it is localized in space and can easily stimulate binocular fixation. Our results indicate that opening the loop of accommodation with a pinhole Maxwellian view or with a 0.2 cpd DOG produces similar response values for tonic accommodative aftereffects and vergence accommodation responses. The decay rate of tonic accommodative aftereffects as well as changes in the resting focus of accommodation caused by vergence accommodation (CA/C) can be measured clinically using dynamic retinoscopy in combination with the DOG target. Clinical values of the CA/C ratio obtained with these techniques were highly correlated (r = 0.92) with laboratory measures obtained with an objective infrared optometer and eye trac monitor.

Accommodation, Ocular↗
PubMed1992

Clinical implications of vergence adaptation.

Placement of a prism in front of an eye results in a change in the tonic position of the eyes, a shift in the forced fixation disparity curve, and a shift in fusional amplitudes. These changes remain in effect as long as motor fusion is maintained. Elimination of fusion by occlusion or by removal of the prism results in a slow movement of the eyes back to the preprism position. This phenomenon, known as prism adaptation or slow fusional vergence, has important clinical implications in maintaining binocular vision with anisometropic prescriptions, age-related physiological changes in the positions of the eyes, blinking, high phorias, etc. Vergence adaptation is useful in explaining previous discrepancies between alternate and unilateral cover test, pre- and postorthoptic ACA ratios, stimulus and response ACA ratios, changes in phorias after orthoptics, and the observation of patients "eating up prism." Vergence adaptation anomalies have been implicated in causing asthenopia. Adaptation has been shown to change after orthoptic therapy. This paper reviews the clinical findings associated with vergence adaptation.

Adaptation, Ocular↗
PubMed1994

An investigation of prism adaptation latency.

PURPOSE: The latency of adaptation of the human vergence system to a change in convergence or divergence forced upon it by a prism was investigated in this pilot study. METHODS: Adaptation was stimulated by a 5-s period of binocular vision through a prism of 0 delta, -8 delta, or 8 delta. Immediately thereafter and for a further period of 45 s, lateral heterophoria was monitored subjectively by an automated version of Duane's screen and parallax test. Adaptation was calculated from the phoria 40 s after the end of binocular vision. Tests were performed at 0.4 m. In the first test session, there was screening during the binocular period to test for flaws in the screening method. In the second session, there was no screening during the binocular period and phoria measurement was started without changing the power of the prism. In the third session, the prism was restored to 0 delta after the period of binocular vision. Immediately after the last 5-s test, tests were repeated with 1 s of binocular vision. The subject had excellent visual acuity, stereoacuity, and stereolatency. RESULTS: The test functioned correctly and showed good repeatability. The greatest adaptation to 8 delta was 59%. This was obtained with only 1 s of binocular vision. There was adaptation to -8 delta with 5 s of binocular vision but it was obscured by adaptation to 0 delta or 8 delta which persisted from previous tests. DISCUSSION: The reason why the subject's latency was not found more precisely is explained. Additional evidence is presented in support of the finding that prism adaptation can take place within 1 s (perhaps less) of binocular vision, and the persistence and dominance of adaptation to base-out prism at near is pointed out. Guidelines are proposed for the experimental measurement of prism adaptation latency.

Adaptation, Ocular↗
PubMed1986

Effects of prolonged forced vergence upon the adaptation system.

In previous studies the ability of the oculomotor system to adapt to prism-induced heterophoria has been shown. The 'phoria that occurs immediately after a prism has been placed before one eye gradually reduces and returns to its original baseline value as the subject is allowed binocular experience while wearing the prism. Little work has been carried out to determine when the adaptation is complete. In this study we report on the results of two experiments designed to determine when adaptation is complete. In the first, the rate of decay of adaptation, i.e. loss of slow fusional vergence, is measured after varying periods of forced vergence. In the second experiment the rate of adaptation to an additional disparity is measured; this should be the same as that before the induced effect if adaptation is complete. The results of this study indicate that although adaptation may appear complete by the criterion that the 'phoria has returned to its baseline value, the adaptation is unlikely to be truly complete for a much longer period of time has passed.

Adaptation, Ocular↗
PubMed2005

An enhancement to the Maddox Wing test for the reliable measurement of horizontal heterophoria.

PURPOSE: To attempt to improve the reliability of the Maddox Wing (MW) test for the measurement of horizontal heterophoria at near. METHODS: Horizontal heterophoria measurements at 30 cm using the MW instrument were made on a group of 58 normally-sighted binocular young adult subjects. The procedures were repeated at each of five weekly visits. The standard tangent scale card provided by the instrument's manufacturer was used as the control condition vs four alternative cards designed to enhance accommodative stimulation and improve operational reliability. RESULTS: A statistically-similar mean near phoria value was recorded using each of the five cards. However one of the alternative card designs produced a small but statistically significantly less variable result than the others: this design featured a much smaller typeface (4pt) than that used for the digits on the standard card, and the horizontal row of numbers was flanked by two periods of a low spatial frequency (< 2 c deg(-1)) square wave grating. CONCLUSIONS: It is suggested that for improved reliability of near phoria measurement when using the MW instrument a more appropriately detailed design of tangent card would promote enhanced accommodation, an operational consideration likely to be especially relevant when examining children.

Accommodation, Ocular↗
PubMed2004

Accommodation and related risk factors associated with myopia progression and their interaction with treatment in COMET children.

PURPOSE: To examine baseline measurements of accommodative lag, phoria, reading distance, amount of near work, and level of myopia as risk factors for progression of myopia and their interaction with treatment over 3 years, in children enrolled in the Correction of Myopia Evaluation Trial (COMET). METHODS: COMET enrolled 469 ethnically diverse children (ages, 6-11 years) with myopia between -1.25 and -4.50 D. They were randomly assigned to either progressive addition lenses (PALs) with a +2.00 addition (n = 235) or single vision lenses (SVLs; n = 234), the conventional spectacle treatment, and were observed for 3 years. The primary outcome measure was progression of myopia by autorefraction after cycloplegia with 2 drops of 1% tropicamide. Other measurements included accommodative response (by an open field of view autorefractor), phoria (by cover test), reading distance, and hours of near work. Independent and interaction analyses were based on the mean of the two eyes. Results were adjusted for important covariates with multiple linear regression. RESULTS: Children with larger accommodative lags (>0.43 D for a 33 cm target) wearing SVLs had the most progression at 3 years. PALs were effective in slowing progression in these children, with statistically significant 3-year treatment effects (mean +/- SE) for those with larger lags in combination with near esophoria (PAL - SVL progression = -1.08 D - [-1.72 D] = 0.64 +/- 0.21 D), shorter reading distances (0.44 +/- 0.20 D), or lower baseline myopia (0.48 +/- 0.15 D). The 3-year treatment effect for larger lags in combination with more hours of near work was 0.42 +/- 0.26 D, which did not reach statistical significance. Statistically significant treatment effects were observed in these four groups at 1 year and became larger from 1 to 3 years. CONCLUSIONS: The results support the COMET rationale (i.e., a role for retinal defocus in myopia progression). In clinical practice in the United States children with large lags of accommodation and near esophoria often are prescribed PALs or bifocals to improve visual performance. Results of this study suggest that such children, if myopic, may have an additional benefit of slowed progression of myopia.

Accommodation, Ocular↗
PubMedDate not supplied

[Study of visual acuity disorders in school children].

The results of an analysis of 475 ophthalmologic examinations in children between eight and nine years old with an electric "Titmus" apparatus, are presented. The main object of the present communication was the detection of early alterations in visual acuteness. The alterations were: Distant visual acuteness: 57; distant lateral phoria 70.1%; distant vertical phoria: 47.3%; color perception (just males) 15.5%. These results stress the importance of the procedure in detecting alterations of visual acuteness in children.

Child↗