Vergence Adaptation Research Articles

Reduced vergence adaptation is associated with a prolonged output of convergence accommodation in convergence insufficiency.

Convergence insufficiency (CI) is a developmental visual anomaly defined clinically by a reduced near point of convergence, a reduced capacity to view through base-out prisms (fusional convergence); coupled with asthenopic symptoms typically blur and diplopia. Experimental studies show reduced vergence parameters and tonic adaptation. Based upon current models of accommodation and vergence, we hypothesize that the reduced vergence adaptation in CI leads to excessive amounts of convergence accommodation (CA). Eleven CI participants (mean age=17.4±2.3 years) were recruited with reduced capacity to view through increasing magnitudes of base out (BO) prisms (mean fusional convergence at 40 cm=12±0.9Δ). Testing followed our previous experimental design for (n=11) binocularly normal adults. Binocular fixation of a difference of Gaussian (DoG) target (0.2 cpd) elicited CA responses during vergence adaptation to a 12Δ BO. Vergence and CA responses were obtained at 3 min intervals over a 15 min period and time course were quantified using exponential decay functions. Results were compared to previously published data on eleven binocular normals. Eight participants completed the study. CI's showed significantly reduced magnitude of vergence adaptation (CI: 2.9Δ vs. normals: 6.6Δ; p=0.01) and CA reduction (CI=0.21 D, Normals=0.55 D; p=0.03). However, the decay time constants for adaptation and CA responses were not significantly different. CA changes were not confounded by changes in tonic accommodation (Change in TA=0.01±0.2D; p=0.8). The reduced magnitude of vergence adaptation found in CI patients resulting in higher levels of CA may potentially explain their clinical findings of reduced positive fusional vergence (PFV) and the common symptom of blur.

Short-term adaptation of accommodation, accommodative vergence and disparity vergence facility

Previous studies have found that subjects can increase the velocity of accommodation using visual exercises such as pencil push ups, flippers, Brock strings and the like and myriad papers have shown improvement in accommodation facility (speed) and sufficiency (amplitude) using subjective tests following vision training but few have objectively measured accommodation before and after training in either normal subjects or in patients diagnosed with accommodative infacility (abnormally slow dynamics). Accommodation is driven either directly by blur or indirectly by way of neural crosslinks from the vergence system. Until now, no study has objectively measured both accommodation and accommodative–vergence before and after vision training and the role vergence might play in modifying the speed of accommodation. In the present study, accommodation and accommodative–vergence were measured with a Purkinje Eye Tracker/optometer before and after normal subjects trained in a flipper-like task in which the stimulus stepped between 0 and 2.5diopters and back for over 200 cycles. Most subjects increased their speed of accommodation as well as their speed of accommodative vergence. Accommodative vergence led the accommodation response by approximately 77ms before training and 100ms after training and the vergence lead was most prominent in subjects with high accommodation and vergence velocities and the vergence leads tended to increase in conjunction with increases in accommodation velocity. We surmise that volitional vergence may help increase accommodation velocity by way of vergence–accommodation cross links.

Effect of heterophoria type and myopia on accommodative and vergence responses during sustained near activity in children

The influence of phoria-type and myopia on changes to vergence and accommodation during prolonged near-task was examined in 53 children. Participants were classified into phoria and refractive categories based on near phoria and cycloplegic refraction respectively. Measures of near phoria, binocular (BA) and monocular accommodation (MA) were obtained before and during a 20min task when children binocularly fixated a high-contrast target at 33cm through best corrective lenses. Vergence adaptation and accommodative adaptation were quantified using changes to near phoria and tonic accommodation respectively. The direction and magnitude of vergence adaptation was modified by the phoria-type (p<0.001). Emmetropic exophores displayed convergent (less exo than baseline) adaptation while esophores showed divergent shifts (less eso than baseline) in phoria upon prolonged fixation. Myopic children also followed a similar pattern but showed greater divergent (or less convergent) shift (p<0.001) in vergence adaptation for all phoria categories compared to emmetropes. Phoria-type also influenced the pattern of BA vs. MA (p<0.001) such that exophores showed BA>MA while esophores showed MA>BA in both refractive groups. Accommodative adaptation was higher in myopes (p=0.010) but did not demonstrate a significant effect of phoria (p=0.4). The influence of phoria-type on vergence adaptation and the pattern of BA vs. MA relates primarily to the varying fusional vergence demands created by the direction of phoria. The greater divergent (or less convergent) shift in vergence adaptation seen in myopes (compared to emmetropes) could be attributed to their higher accommodative adaptation. Nevertheless, the adaptive patterns observed in myopic children do not appear to explain their high response AV/A ratios identified as a risk factor for myopia development.

A dual visual-local feedback model of the vergence eye movement system

Pure vergence movements are the eye movements that we make when we change our binocular fixation between targets differing in distance but not in direction relative to the head. Pure vergence is slow and controlled by visual feedback. Saccades are the rapid eye movements that we make between targets differing in direction. Saccades are extremely fast and controlled by a local, non-visual feedback loop. Usually, we change our fixation between targets that differ in both distance and direction. Then, vergence eye movements are combined with saccades. A number of models have been proposed to explain the dynamics of saccade-related vergence movements. The models have in common that visual input is ignored for the duration of the responses. This type of control is realistic for saccades but not for vergence. Here, I present computations performed to investigate if a model using dual visual and local feedback can replace the current models. Simulations and stability analysis lead to a model that computes an estimate of target vergence instead of retinal disparity and uses this signal as the main drive. Further analysis shows that the model describes the dynamics of pure vergence responses over the full physiological range, saccade-related vergence movements, and vergence adaptation. The structure of the model leads to new hypotheses about the control of vergence.

Is tonic vergence protective against strabismus during development?

Young children have increased accommodative demand due to their typically hyperopic refractive error, while they have reduced vergence demand relative to adults, due to their decreased interpupillary distance. The neural coupling of accommodation and vergence implies that young children may experience an apparent cue conflict for stable accommodative and vergence responses (Bharadwaj & Candy, 2009). Some children develop strabismus, potentially resulting from this conflict (Parks, 1958). How most children are able to avoid strabismus is poorly understood. The purpose of this study was to determine whether tonic adaptation of vergence might protect young children from this conflict by reducing the impact of the neural coupling. Participants were 3- to 10-year-old typically-developing children and adults, who watched a video at a 33cm viewing distance. They initially viewed it monocularly to determine their baseline heterophoria (with a near IR filter and MCS PowerRefractor, 25Hz). They then watched the video binocularly for 5 or 60 sec, after which their alignment with the filter was measured again to determine the time constant over which they returned to their baseline heterphoria (Schor & Horner, 1989). The mean phoria at the task distance in adults was 4.4 pd (±2.9) exophoria and in children was 3.5 pd (±3.9) exophoria (p = 0.60). For these tasks the mean time constants only differed by 1.5sec (p = 0.40) (after 5sec viewing) and 1.8sec (p = 0.54) (after 60sec viewing) between the adults and children. Thus the balance of tonic adaptation and phasic activity appear similar for children and adults for these tasks. Given that tonic vergence is active in adults (Schor, 1979), the fact that the data from children were comparable to adults' indicates that tonic vergence could play a role in achieving alignment during development.

Vergence Adaptation in Subjects with Convergence Excess

The main purpose of this study was to evaluate the vergence adaptive ability in subjects diagnosed with convergence excess (CE) phoria (ie, subjects with an esophoric shift from distance to near but without an intermittent tropia at near). Vergence adaptation was measured at far and near with both base-in and base-out prisms using a “flashed” Maddox rod technique in 20 control subjects and 16 subjects with CE. In addition, accommodative adaptation and the stimulus AC/A and CA/C cross-links were measured. The AC/A and CA/C ratios were found to be high and low, respectively, and accommodative adaptation was found to be reduced in CE subjects as compared with the controls (P<0.005), all as predicted by the present theory. However, vergence adaptive ability was found to be reduced in the CE subjects at both distance and near and in response to both base-in and base-out prisms (P=0.002). This finding is not in accordance with and is difficult to reconcile with the present theory of CE.

Incomitant Strabismus

The paradigm that an "underacting" extraocular muscle is always atrophic or hypoplastic and that an overacting extraocular muscle should always be enlarged leads to inconsistencies with clinical observations. These include findings of "overacting" inferior oblique muscles, superior rectus muscle overaction or contracture syndrome, and normal extraocular muscle diameters in patients with apparent superior oblique muscle palsy, among other clinical entities. These inconsistencies can be reconciled if one accepts the possibility that extraocular muscle contractile activity may reflect a change in neural input to an anatomically normal muscle or that muscle contractile activity may be altered by shifts in fiber type and distribution within a normal-sized muscle. This remodeling may result from vergence adaptation or from any change in neural stimulus to the muscle. There is substantial evidence to suggest that both of these theoretical possibilities may likely occur.

Incomitant Strabismus: Does Extraocular Muscle form Denote Function?

The paradigm that an underacting extraocular muscle (EOM) is always atrophic or hypoplastic, and an overacting EOM should always be enlarged, leads to inconsistencies with clinical observations. It is inconsistent with the findings of normal extraocular muscle diameters in patients with apparent superior oblique muscle palsy, “overacting” inferior oblique muscles, and the superior rectus muscle overaction/contracture syndrome, among other clinical entities. These inconsistencies can be reconciled if one accepts the possibility that EOM contractile activity may reflect a change in neural input to an anatomically normal muscle, and/or that muscle contractile activity may be altered by a shift in fiber type and distribution within a normal-sized muscle. This remodeling may occur as a result of vergence adaptation or any change in neural stimulus to the muscle. There is substantial evidence to suggest that both these theoretical possibilities may likely occur.

Comments on "Effect of Vergence Adaptation on Convergence Accommodation: Model Simulations

Sreenivasan et al. have used an inappropriate measure to estimate convergence accommodation under closed-loop (CL) accommodation and vergence, which they then used to compare the two adaptation models. In [1, Fig. 8(b)], they used a dual-scale plot to exaggerate the small change in experimental dynamics, but such a plot could only appropriately provide a comparison of steady-state level responses. Quantitative analysis of the static model of accommodation and vergence showed that subtraction of CL and open-loop (OL) responses resulted in a small numerical value, which is close to the authors' experimentally derived value. The authors had assumed erroneously that such a difference would represent the convergence accommodation response. But their value is very different from the large numerical value for convergence accommodation calculated analytically. In the model simulations, the large difference in steady-state convergence accommodation levels for the two models provides a means to assess their appropriateness. Schor's model response exhibited a very small value. On the other hand, Hung's model response exhibited a large value, which is close to the level calculated analytically.

Vergence adaptation in clinical vergence testing

Background The purposes of this investigation were to determine whether vergence adaptation occurs after vergence range testing and vergence facility testing and to determine whether vergence adaptation correlates with the results of these tests. Methods Thirty subjects participated in 3 testing sessions on different days. During each session 1 of the following was tested: base-out prism bar vergences, vergence facility (12 base-out/3 base-in binocular prism flippers for 1 minute), and 5 minutes viewing with 6 prism diopters of base-out prism. Before and after each test, the near phoria was measured using the modified Thorington method. Results There was no correlation between the amplitude of the vergence ranges and the amplitude of vergence facility. Significant vergence adaptation as indicated by an esophoric shift of approximately 3 prism diopters occurred in all testing sessions. The amplitude of vergence adaptation did not correlate with either the amplitude of the blur vergence range or vergence facility. There was a significant correlation between the amplitude of vergence adaptation and the amplitude of the break vergence range. Conclusions The lack of correlation between the blur vergence range and the vergence facility is not likely because of vergence adaptation. The lack of correlation between the break vergence range and the vergence facility may be in part caused by vergence adaptation.

Effect of Vergence Adaptation and Positive Fusional Vergence Training on Oculomotor Parameters

Clinical studies have shown that positive fusional vergence (PFV) can be trained through a program of orthoptic exercises. Models of accommodation and vergence predict that training PFV would require a reduction in the convergence accommodation (CA) cross-link. Recent investigations have found that the CA/C ratio is not changed in a clinical population after orthoptics. We hypothesized that such orthoptic programs may instead act to reduce CA through changes in the relationship between fast and slow vergence components. METHODS.: Eleven visually normal subjects were tested. Phoria adaptation to a 12-Delta base-out (BO) wedge prism and the resulting CA responses were monitored every 3 min for 15 min to a DoG target at 0.4 m. These measures were repeated after 2 weeks of orthoptics. Phorias, stimulus accommodative convergence (AC)/A and CA/C ratios, and PFV amplitudes at near were also determined. Before the orthoptics program, these measures were repeated under "adapted" conditions. Phoria adaptation following prolonged viewing through the 12-Delta BO wedge prism was associated with a concomitant reduction in the CA. These changes were asymptotic over time with 95% of the change occurring within the first 3 to 6 min. After 2 week of orthoptics, the rates and magnitudes of both phoria adaptation and CA reduction increased significantly (p < 0.01). PFV at 40-cm limits showed increases with orthoptics and under vergence adaptation. CA/C and AC/A ratios were unchanged after orthoptics, but the former was reduced, and the latter increased under the vergence adapted condition. Orthoptics acts to change the time constant and magnitude of vergence adaptation to BO prisms, which leads to a concomitant reduction of CA over a similar time course. This process appears to underlie the increase in positive fusion limits. Although reductions in CA/C ratio occur under the vergence adapted state, this ratio is not directly changed with orthoptics.

Differences between phoria and vergence adaptation in myopic children with esophoria

Differences between phoria and vergence adaptation in myopic children with esophoria

The effect of artificially reduced bilateral visual acuity on vergence adaptation

Aim: To investigate the effect of bilateral artificially reduced vision on vergence adaptation, in participants with normal binocular single vision. Methods: Seventeen participants were recruited from a student population. The inclusion criteria included the ability to adapt to a 6 Δ base-out prism to within ±1 Δ of the baseline heterophoria measurement in 10 minutes. The size of the prism-induced heterophoria was measured at the start and end of the adaptation period using a Maddox rod and tangent scale. Eleven participants fitted the inclusion criteria and proceeded to a second visit; involving adaptation to a 6 Δ base-out prism within 10 minutes, whilst vision was bilaterally reduced with Bangerter foils (0.3). Participants who did not demonstrate adaptation to within ±1 Δ of the baseline measure in 10 minutes were given a further 10 minutes to adapt, with the size of the residual deviation being measured at 5-minute intervals. Results: Eight of 11 participants demonstrated vergence adaptation to within ±1 Δ of the baseline measure in 10 minutes when vision was bilaterally reduced. Three participants required an additional 5 minutes before they achieved this level of adaptation. Statistical analysis revealed the rate of vergence adaptation was affected in some participants when vision was bilaterally reduced (p = 0.0260, t = 2.6116, d.f. =10). Conclusion: Individuals who demonstrate vergence adaptation in normal viewing conditions appear capable of doing this with an artificial bilateral reduction in vision. In some participants, a longer period of time is required to vergence-adapt.

Effect of Vergence Adaptation on Convergence–Accommodation: Model Simulations

Several theoretical control models depict the adaptation effects observed in the accommodation and vergence mechanisms of the human visual system. Two current quantitative models differ in their approach of defining adaptation and in identifying the effect of controller adaptation on their respective cross-links between the vergence and accommodative systems. Here, we compare the simulation results of these adaptation models with empirical data obtained from emmetropic adults when they performed sustained near task through + 2D lens addition. The results of our experimental study showed an initial increase in exophoria (a divergent open-loop vergence position) and convergence-accommodation (CA) when viewing through +2D lenses. Prolonged fixation through the near addition lenses initiated vergence adaptation, which reduced the lens-induced exophoria and resulted in a concurrent reduction of CA. Both models showed good agreement with empirical measures of vergence adaptation. However, only one model predicted the experimental time course of reduction in CA. The pattern of our empirical results seem to be best described by the adaptation model that indicates the total vergence response to be a sum of two controllers, phasic and tonic, with the output of phasic controller providing input to the cross-link interactions.

Binocular Adaptation to +2 D Lenses in Myopic and Emmetropic Children

To compare vergence adaptation to +2 D addition lenses in myopic and emmetropic children and to evaluate the influence of the accommodative-vergence crosslink (AC/A ratio) on this adaptation. Nine myopic and 11 emmetropic children fixated a near target at a distance of 33 cm. Measures of binocular and monocular accommodation and phoria were obtained during a 20-min near task with and without +2 D lenses. Response AC/A ratios were determined from the experimental results. Vergence adaptation was quantified by the magnitude of reduction in phoria and the percentage of completeness (PC, return of adapted phoria to habitual level) after the near task. Myopic children showed significantly higher AC/A ratios, which led to greater lens-induced exophoria and a greater demand for vergence adaptation. Both refractive groups showed significant vergence adaptation; however, myopes exhibited significantly reduced (p < 0.01) magnitudes compared with emmetropes (myopes = 3.95 +/- 0.15 Delta; emmetropes = 4.41 +/- 0.08 Delta). The mean PC was also significantly (p < 0.001) reduced in myopes (61.02 +/- 1.57) compared with emmetropes (76.6 +/- 2.10). There was a significant correlation between magnitude of adaptation and AC/A in both the refractive groups; however, myopes consistently showed reduced magnitudes compared to emmetropes. AC/A ratio influenced PC in emmetropic but not myopic children. In the accommodation system, +2 D lenses eliminated the accommodative lags observed in myopic children during natural viewing conditions. These lenses resulted in a small over-focus (-0.24 +/- 0.27 D) at the onset of near work, which decreased during sustained viewing through the near add. Myopic children demonstrate reduced magnitude and completeness of vergence adaptation to +2 D lenses. The magnitude of vergence adaptation varied with AC/A in both refractive groups; however, the presence of myopia differentiated the amount of adaptation for all AC/A ratios. Conversely, the degree of completeness appears to be primarily associated with the type of refractive error.

The influence of vergence adaptation on open-loop vergence dynamics

The objectives of this experiment were to measure the effect of sustained convergence on the open-loop vergence peak velocity and open-loop vergence amplitude, and to assess the correlation between changes in the phoria and changes in open-loop vergence peak velocity induced by sustained convergence. Subjects sustained convergence on a target that required 12° of convergence for 5 minutes. Convergence and divergence movements of 4° from the 12° convergent position were measured before and after sustained convergence. Following sustained convergence, the open-loop vergence peak velocity and vergence amplitude both increased for convergence (regression slope = 3.68, r = 0.47). Vergence velocity and vergence amplitude both decreased for divergence (regression slope = 1.76, r = 0.36). After sustained convergence, a convergent shift in the phoria was noted in most cases. This shift correlated with changes in open-loop peak vergence velocity more for convergence (regression slope = 1.1, r = 0.33) than for divergence (regression slope = 0.71, r = 0.22). The results might be due to shifts in disparity detection brought about by the period of sustained convergence.

127: Vertical vergence adaptation produces a transient cyclovertical deviation changing with head tilt

Introduction: With the aim of understanding the mechanisms involved in both binocular fusion and ocular misalignment, we asked normal volunteers to adapt to a steadily increasing vertical misalignment.

Binocular adaptation to near addition lenses in emmetropic adults

Near addition lenses are prescribed to pre-presbyopic individuals for treatment of binocular motor problems such as convergence excess and to control the progression of myopia. To date, no investigation has looked at the complete sequence of binocular motor responses during a period of near work with +2 D lenses. This investigation evaluated changes to accommodation and vergence responses when young adults sustained fixation at 33 cm with +2 D addition lenses. In addition, the effect of the accommodative vergence cross-link (AV/A) on the magnitude and the completeness of binocular adaptation to these lenses were evaluated. The results showed that +2 D lenses initiate an increase in exophoria and convergence driven accommodation. The degree of the initial induced phoria was dependant upon the magnitude of the AV/A ratio. Vergence adaptation occurred after 3 min of near fixation and reduced the exophoria and convergence driven accommodation. The magnitude of vergence adaptation was dependant upon the size of the induced phoria and hence the AV/A ratio. The completeness of adaptation was seen to vary inversely with induced exophoria and thus the AV/A ratio.

Stereoacuity is affected by induced phoria but returns toward baseline during vergence adaptation

In normal binocular single vision adaptation to an induced deviation occurs over a period of several minutes. This study investigates the effect on stereoacuity during vergence adaptation. Stereoacuity, using the Frisby near stereotest, was measured in 20 participants aged 20.2 +/- 1.9 years with normal binocular single vision. Measurements were taken immediately on inducing a phoria with 12(Delta) base-out prisms (split), and after 3, 6, and 9 minutes of adaptation. A measure of stereoacuity was also taken with the same size prisms that were used concomitantly to control for the reduced visual acuity. Stereoacuity was found to decrease following introduction of the 12(Delta) base-out prismatic glasses (9.4 +/- 2.5 arcsec compared with 24.4 +/- 21.4 arcsec) and then increase over the 9 minute period of adaptation (ANOVA, p = 0.0002). Using post-hoc tests with Bonferroni correction, the decrease of stereoacuity on introduction of the prism was significant (p = 0.0039), and although an increase in stereoacuity appeared to occur after 3 and 6 minutes of wearing the 12(Delta) glasses (14.9 +/- 4.3 arcsec, 12.3 +/- 4.5 arcsec), this did not return to the baseline value until 9 minutes, when the stereoacuity had increased to 12.6 +/- 10.6 arcsec (p = 0.1982). In these participants, inducing a deviation with base-out prisms negatively affected near stereoacuity. However, as adaptation occurred, the level of stereoacuity was seen to increase back toward the baseline measurement.

Esotropia Associated With Early Presbyopia Caused by Inappropriate Muscle Length Adaptation

The purpose of this study is to investigate the occurrence of esotropia accompanying early presbyopia. The two primary long-term mechanisms for maintenance of ocular alignment are vergence adaptation (neurologic) and muscle length adaptation (anatomic). Both mechanisms depend upon disparity-driven motor fusion for proper operation. A possible cause for an esotropic shift in early presbyopic adults with insufficient or absent disparity-driven motor fusion is inappropriate muscle length adaptation (medial rectus muscle shortening) occurring in response to increased convergence tonus accompanying increased accommodative effort. Of 617 patients, age 10 and older who underwent surgery for esotropia during the period of 1980 to 1996, the age when the deviation occurred or worsened could be determined with confidence in 140. A plot was made of the number of these patients versus the age of onset of the deviation. This was compared with a similar plot of patients operated for exotropia. A statistically significant increase (P = 0.017) in the incidence of an esotropic shift in the age range from 30 to 50 years was found when compared with the incidence of an exotropic shift. If the postulated mechanism is correct, full correction of any hyperopia as well as prompt prescription of a reading add (or conversion to monovision correction) may help prevent further progression of small esodeviations accompanying early presbyopia.