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The symptoms and signs associated with convergence insufficiency are related to prolonged, visually demanding, near-centered tasks. They may include, but are not limited to, diplopia (double vision), asthenopia (eye strain), transient blurred vision, difficulty sustaining near-visual function, abnormal fatigue, headache, and abnormal postural adaptation, among others.
Convergence insufficiency - usually associated with accommodative difficulties, the fusional convergence range of these patients is reduced. Divergence insufficiency- although rare and usually associated with a neurological condition, the PFR is able to detect a reduced divergence range.
The Brock string is commonly employed during treatment of convergence insufficiency and other anomalies of binocular vision. It is used to develop skills of convergence as well as to disrupt suppression of one of the eyes. [1] During therapy, the one end of the Brock string is held on the tip of the nose while the other is tied to a fixed point.
Accommodative excess may occur secondary to convergence insufficiency also. In convergence insufficiency near point of convergence will recede, and positive fusional vergence (PFV) will reduce. So, the patient uses excessive accommodation to stimulate accommodative convergence to overcome reduced PFV.
Accommodative insufficiency (AI) involves the inability of the eye to focus properly on an object. Accommodation is the adjustment of the curvature of the lens to focus on objects near and far. In this condition, amplitude of accommodation of a person is lesser compared to physiological limits for his age. [ 1 ]
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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.
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