Abnormal Accommodative Convergence Accommodation Ratio

When the accommodative convergence/accommodation ratio is abnormal, the angle of deviation may fluctuate depending on whether the fixated object is far or near. For example in accommodative esotropia, the angle of deviation is larger with close objects than with distant objects. The disorder is corrected with bifocal eyeglasses, which in the case of accommodative esotropia have a strong near-field correction (Fig. 17.5a and b). A residual angle of deviation may remain despite the eyeglass correction. However, the angle of deviation may also improve to the point that the visual axes are parallel with good binocular vision.

— Accommodative esotropia in the right eye.

— Accommodative esotropia in the right eye.

Bifocals For Accommodative Esotropia

Fig. 17.5 a Gaze is directed through the distance portion of bifocals.

b Gaze is directed through the near-field portion of the bifocals. The arrow indicates the dividing line between the distance and near-field portions.

Fig. 17.5 a Gaze is directed through the distance portion of bifocals.

b Gaze is directed through the near-field portion of the bifocals. The arrow indicates the dividing line between the distance and near-field portions.

An abnormal accommodative convergence/accommodation ratio will cause fluctuations in ocular deviation in near and distance fixation.

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