Influence of accommodative and vergence adaptation on binocular motor disorders

Tait described four categories of binocular disorders including convergence excess, convergence insufficiency, divergence excess, and divergence insufficiency. These disorders are defined by the distance where the largest heterophoria occurs (distance or near), and the amplitude of the accommodative vergence ratio (AC/A). Insufficiency corresponds to a low AC/A ratio, whereas excess corresponds to a high AC/A. The magnitude of the AC/A ratio, which may be influenced by the adaptability of the accommodation and vergence systems, has been shown to be reciprocally related to adaptability of accommodation. Likewise, the degree of vergence accommodation has been shown to be related reciprocally to adaptability of vergence to prism. An imbalance of adaptability of accommodation and vergence systems produces abnormal cross-coupling between the two motor systems. When accommodation is more adaptable than vergence, the AC/A ratio is low and the CA/C ratio is high. Conversely, when vergence is more adaptable than accommodation, the AC/A ratio is high and the CA/C ratio is low. A method is reported for temporarily restoring moderate amplitudes of abnormal AC/A and CA/C ratios by reducing excessive adaptation with fatigue. Finally, new clinical procedures for measuring adaptation of accommodation and the CA/C ratio are presented. Taken together with current measures of vergence adaptation and AC/A ratio these procedures will permit a more complete evaluation of mutual interactions between accommodation and vergence in patients diagnosed as having excessive and insufficient vergence.