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[Dissociated near reflex and accommodative convergence excess]
1Augenklinik für Schielbehandlung und Neuroophthalmologie, Justus-Liebig-Universität, Giessen. michael.h.graef@augen.med.uni-giessen.de
Summary
This study highlights a rare case of a near reflex only in the left eye of an 8-year-old boy. Bifocal glasses corrected this visual anomaly, restoring binocular function and stereopsis.
Area of Science:
- Ophthalmology
- Neuroscience
- Pediatric Optometry
Background:
- The near reflex, crucial for clear vision at close distances, involves accommodation and pupillary constriction.
- Disruptions in the near reflex can significantly impact visual function and binocularity.
Observation:
- An 8-year-old boy presented with a near reflex exclusively elicited when his left eye was fixing (LF), but absent when his right eye was fixing (RF).
- Initial examination revealed reduced visual acuity at near and significant esotropia at 3 meters when the left eye was fixing.
- Accommodation and pupillary near reaction were impaired during right eye fixation.
Findings:
- During left eye fixation, retinoscopy demonstrated 8 D of accommodation and normal pupillary constriction.
- The patient exhibited esophoria at distance and varying phorias/tropias at near, dependent on fixation eye.
- Correction with bifocal glasses normalized binocular alignment (orthotropia) and enabled stereopsis at near.
Implications:
- This case underscores the importance of assessing eye-specific responses within the near reflex system.
- Bifocal correction can be an effective treatment for complex binocular vision anomalies involving the near reflex.
- Further research into the neural underpinnings of asymmetric near reflex responses is warranted.