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In studies that used standardized definitions of convergence insufficiency, investigators have reported a prevalence of 4.2–6% in school and clinic settings. The standard definition of convergence insufficiency is exophoria greater at near than at distance, a receded near point of convergence, and reduced convergence amplitudes at near. [5]
In this, distances vary for individuals from the far point—the maximum distance from the eye for which a clear image of an object can be seen, to the near point—the minimum distance for a clear image. Accommodation usually acts like a reflex, including part of the accommodation-convergence reflex, but it can also be consciously controlled.
Light from a single point of a distant object and light from a single point of a near object being brought to a focus. The accommodation reflex (or accommodation-convergence reflex) is a reflex action of the eye, in response to focusing on a near object, then looking at a distant object (and vice versa), comprising coordinated changes in vergence, lens shape (accommodation) and pupil size.
Negative relative accommodation (NRA) was proposed by Joseph Kearney of Oxford University in 1967 as a measure of the maximum ability to relax accommodation while maintaining clear, single binocular vision.
Convergence excess; Divergence insufficiency; Fusional vergence dysfunction (reduced positive and negative fusional vergence, with normal or near-normal phoria) Heterophoria; Vergence control, and over-convergence associated with the extra accommodation required to overcome a hyperopic refractive error, play a role in the onset of accommodative ...
Accommodative excess may occur secondary to convergence insufficiency also. In convergence insufficiency near point of convergence will recede, and positive fusional vergence (PFV) will reduce. So, the patient uses excessive accommodation to stimulate accommodative convergence to overcome reduced PFV.
Clinically, accommodative convergence is measured as a ratio of convergence, measured in prism diopters, to accommodation, measured in diopters of near demand. The patient is instructed to make a near target perfectly clear and their phoria is measured as the focusing demand on the eye is changed with lenses.
Both of these mechanisms are neurally linked forming the accommodation-convergence reflex [1] of eyes. One can distinguish vergence distance — a distance of a point towards which both eyes are converging, and an accommodation distance — a distance of a region in space towards which the focus or refractive power of the ...