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Related Experiment Video

Updated: Mar 30, 2026

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Tenacious Proximal Fusion: The Scobee Phenomenon.

Burton J Kushner1

  • 1From the Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, Wisconsin. bkushner@wisc.edu.

The American Orthoptic Journal
|November 14, 2015
PubMed
Summary

The "Scobee Phenomenon" explains increased near deviation in intermittent exotropia, driven by binasal retinal disparity and uncrossed localization during near fixation, not tenacious proximal fusion.

Keywords:
accommodative convergenceintermittent exotropiatenacious proximal fusionthe Scobee Phenomenon

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Area of Science:

  • Ophthalmology
  • Binocular Vision
  • Neuroscience

Background:

  • Intermittent exotropia can exhibit increased near deviation after monocular occlusion.
  • This phenomenon, previously termed tenacious proximal fusion (TPF), is not fully descriptive.
  • TPF can occur even without prior fusion opportunities.

Purpose of the Study:

  • To investigate if binasal retinal disparity and uncrossed localization mediate the increased near deviation in intermittent exotropia.
  • To explore the underlying mechanisms of the TPF phenomenon.

Main Methods:

  • Studied ten patients with intermittent exotropia exhibiting TPF.
  • Measurements taken at distance, near, near after monocular occlusion, and with a peripheral crossed localization stimulating device (PCLSD).
  • PCLSD simulated distance fixation's retinal disparity and localization cues.

Main Results:

  • Mean distance deviation was 28.3Δ.
  • Mean initial near deviation was 4Δ.
  • Mean near deviation after occlusion was 25.3Δ, and with PCLSD was 18.5Δ.
  • Significant differences were found between initial near, PCLSD, and post-occlusion measurements (P<0.001, P=0.0049).

Conclusions:

  • The phenomenon previously called TPF is likely convergence induced by binasal retinal disparity and uncrossed localization typical of near fixation.
  • Proposes replacing the term TPF with the "Scobee Phenomenon" for clarity.
  • Highlights the role of visual cues in near deviation in intermittent exotropia.