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The reflex, controlled by the parasympathetic nervous system, involves three responses: pupil constriction, lens accommodation, and convergence. A near object (for example, a computer screen) subtends a large area in the visual field, i.e. the eyes receive light from wide angles. When moving focus from a distant to a near object, the eyes converge.
Convergence of the eyes, or the orientation of the visual axis of each eye towards an object in order to focus its image on each fovea, is the first of the three responses. This can be observed by the cross-eyed movement of the eyes when a finger is held up in front of a face and moved towards the face. Next, constriction of the pupil occurs.
Clinically, accommodative convergence is measured as a ratio of convergence, measured in prism diopters, to accommodation, measured in diopters of near demand. The patient is instructed to make a near target perfectly clear and their phoria is measured as the focusing demand on the eye is changed with lenses.
In this, distances vary for individuals from the far point—the maximum distance from the eye for which a clear image of an object can be seen, to the near point—the minimum distance for a clear image. Accommodation usually acts like a reflex, including part of the accommodation-convergence reflex, but it can also be consciously controlled.
Pupillary light reflex and accommodation reflex tests Argyll Robertson pupils ( AR pupils ) are bilateral small pupils that reduce in size on a near object (i.e., they accommodate ), but do not constrict when exposed to bright light (i.e., they do not react).
Pupillary response is a physiological response that varies the size of the pupil between 1.5 mm and 8 mm, [1] via the optic and oculomotor cranial nerve. A constriction response ( miosis ), [ 2 ] is the narrowing of the pupil, which may be caused by scleral buckles or drugs such as opiates / opioids or anti-hypertension medications.
The Edinger-Westphal nucleus moderates pupil dilation and aids (since it provides parasympathetic fibers) in convergence of the eyes and lens adjustment. [21] Nuclei of the optic tract are involved in smooth pursuit eye movement and the accommodation reflex, as well as REM.
Incorrect vergence response can cause double vision. Accommodation is the eye’s focusing mechanism and it is engaged to produce a sharp image on a retina. Both of these mechanisms are neurally linked forming the accommodation-convergence reflex [1] of eyes.