Accommodative insufficiency:
prepresb; uncorrected hyperopia or over minused myopia;
-while reading both eyes open, place 4PD Base IN front of eye: blurs it if AI; improves it if CI;
-benefit from reading glasses with BASE IN prism (can happen in adolescents rarely for brief time)
Convergenge Insufficiency:
-Exophorai at near
-poor near-fusional convergence amplitudes
-low accommodative convergence/accommodative AC/A ratio
-a remote near point of convergence
-Low break point (10-15PD):1. focus on near letter 0.5; 2. take BASE OUT prism bar increase till sees double: this is Break Point; 3. slowly decrease BO prism till sees 1 object: this is recovery point
-Low Recovery Point
-NORMAL NEAR POINT: <8cm
RX:
1. undercorrect Hyperopia; fully correct myopia
2. Near point exercises; pencil push ups; 15x, 5x per day
3. Near Point exercises with base out prisms: hold 6D BO prism in front of 1eye with pencil push ups
4. Good lighting & relaxation time between periods of close work
5. If this does not work, or older pt, READING GLASSES with Base IN BI prisms can help;
Convergence Paralysis: dt lesion in corpora quadrigemina or CN3 nucleus; may be associated with Parinaud syndrome; stat MRI coronal,
-acute XT
-diplopia Near only
-normal adduction & accommodation