NON-STRABISMIC DYSFUNCTION

NON-STRABISMIC DYSFUNCTIONS
1. Accommodation
2. Vergence:
a. Heterophoria
b. AC/A ratio
c. FD
d. AP
3. Accommodative-vergence (binocularity)
4. Suppression
5. Aniseikonia (anisometropia)
6. Amblyopia
7. Presbyopia
ACCOMMODATION
Symptoms
That occur in other types of disorders as well:
1. Headaches
2. Asthenopia
3. Tired eyes
4. Lack of concentration

Investigation

More directly related to the accommodative system: Blur

Distance/near
Intermittently/after time
Monocularly/binocularly
Amplitude
#19
Push up
Flexibility
Flippers
Hart chart
Negative lenses
Sustainability
Time to blur
Excess
Myopia
Esophoria
Posture/respon
Dynamic ret
se
#14a,b
Autorefractor
NRA/PRA
Duochrome

Accommodative insufficiency
Definition
When there isnt enough accommodative ability to perform ones
everyday activities
Low amplitude
Low amplitude
Presbyopes > expected
12 years > could be due to:
1. Drugs
2. Trauma
3. Neurology
4. Fatigue
5. Lesions
6. Tumours
Treatment
Plus lenses
For near?
Monocular vs binocular vs
binocular
Minus lenses
Initially low powers
Maybe plus lens flippers
Systemic problems and drugs
affecting acc
Accommoative sustainability
Definition
Inability to change accommodative response to accommodate/
de-accommodate type stimuli
Result
Slow/No response to accommodative/de-accommodative demand
Sx
Far-to-near and near-to-far blur
Treatment
1. Flippers
2. Hart chart
3. Minus lenses
4. Robbins rock
5. Lenses (?)
Accommodative spasm
Definition
Pseudo-myope
When accommodative system goes into spasm and
accommodates excessively
Presentation
Long-term/intermittent
Reduced/erratic VA
Minus projectors
Treatment
Difficult
Try to get patient to accept plus lenses
Therapy through plus where possible:
1. Only prescribe plus lenses once they can accept them (initially
contraindicated)
2. Move target while always keeping it clear
Accommodative lag:
Questions
What is lag?
What does it tell us?

How do we measure it?

Do we need to do anything about it?

VERGENCE
Type of problems that affect the vergence system:
1. Near point of convergence
2. Duanes classification:
a. Convergence excess
b. Convergence insufficiency
c. Divergence excess
d. Divergence insufficiency
e. Basic exo
f. Basic eso
3. Heterophoria:
a. Compensated
b. Uncompensated
4. Vergence flexibility
Investigation of vergence system: