Frequency analysis of accommodation,accommodative vergence and disparity vergence

Engineering control analysis is used to gain some insight into the nature of the prediction operator and the synkinesis in the near response triad. The frequency characteristics of accommodation, accommodative vergence and disparity vergence systems are compared on a single subject. The prediction operator seems to be apparent in the accommodation and accommodative vergence system.The triadic interactions are complex and exhibit an adaptive nature; some indirect evidence is also provided for an accommodative vergence synkinetic processor.     

Noise coupling between accommodation and accommodative vergence

For monocular viewing, the fluctuations in accommodative lens power in the frequency range ½−3 Hz were found to be considerably greater than those in accommodative vergence movements of the covered eye. Considering the close synkinesis between these motor responses for step changes or slow variations in accommodative stimulus, this finding is unexpected. This apparent lack of synkinesis is found to result mainly from the more rapid decrease in small signal linear gain with increasing frequency of the accommodative vergence system than of the accommodation system, rather than from some nonlinear phenomenon.     

Experimental evidence for separate mechanisms mediating accommodative vergence and vergence accommodation

An experiment is described which qualitatively measures the state of accommodative vergence under binocular viewing conditions. Results show that under conditions of forced vergence, accommodative vergence maintains a value considerably different from vergence accommodation. These results indicated that accommodative vergence and vergence accommodation are mediated by separate neural processes.     

Proximally induced accommodation and accommodative adaptation

To determine the effect of proximally induced accommodation (PIA) on accommodative adaptation, this study has examined the posttask shift in tonic accommodation (TA) following 5-min monocular viewing of equivalent-sized targets located at distances of 0.33 and 5 m. The distal target was viewed through a negative lens to equate the dioptric stimuli (3 D). The steady-state accommodative response was measured subjectively in 10 subjects using a Hartinger coincidence optometer. A significant correlation was observed between the degree of adaptation following the two conditions, with the magnitude of adaptation for the distal target being approximately half that for the nearer target. Furthermore, adaptation magnitude was inversely correlated with pretask TA under both conditions. These results indicate that PIA can produce accommodative adaptation. The implications of this finding are discussed with regard to models of the accommodative mechanism.     

聚散灵敏度与融像性聚散的相关性研究

目的 探讨聚散灵敏度与融像性聚散的相关性,为临床聚散系统异常的诊断提供更直接、更有意义的指标.方法 临床病例自身对照研究.对2012年10～12月在天津医科大学眼科中心志愿随机抽取50名20～28周岁在校近视大学生,应用电脑验光仪和综合验光仪行规范验光后,在屈光不正全矫的基础上分别进行聚散灵敏度检测和融像性聚散检测,并利用Flashed Von Graefe法测量视近隐斜,利用SPSS 13.0统计软件对相关数据进行分析,确定聚散灵敏度与融像性聚散的相关性.结果 (1)视近隐斜偏高组(＞6EXO)和视近隐斜正常组(0-6EXO)的聚散灵敏度差异显著有统计学意义(P＜0.05),而融合性聚散(BI)恢复点数值差异无统计学意义(P＞0.05).(2) BI模糊点和破裂点与聚散灵敏度无相关性,而其恢复点与聚散灵敏度有相关性.结论 可以通过被检者的恢复点数值推测患者的聚散灵敏度是否异常,可使聚散检测中恢复点数据得到充分的使用,从而减少了专项的聚散灵敏度检查,使双眼视异常的诊断更为简便.     

Influence of proximal,accommodative and disparity stimuli upon the vergence system*

The most important cues to the normal vergence response are retinal disparity, accommodative effort and perceived distance (proximal cue). In the past, proximal cues have been thought to contribute little to the total vergence response but more recent studies have suggested that they play an important role. The relative contributions of the proximal, accommodative and disparity cues to the vergence response were assessed by measuring the effect upon the vergence system when each of these cues were altered. The effect upon the vergence system was measured by the change in ‘phoria, the change of fixation disparity and the amount of prism adaptation after 210 s of binocular viewing. The results indicate that the greatest effect of cue disharmony occurred when the proximal and disparity cues were altered. A finding which signifies the importance of the proximal cue to the overall vergence response.     

Clinical method for measuring adaptation of tonic accommodation and vergence accommodation

Previous work indicates that tonic adapters of accommodation and vergence have indirect effects on accommodative vergence and vergence accommodation and that these crosslink responses interact with one another to produce clear and single vision. Clinical measurements of tonic accommodation, tonic vergence, vergence accommodation (CA/C ratio), and accommodative vergence (AC/A ratio) are therefore of value in determining possible binocular vision abnormalities. Currently, clinical methods are only available for measuring the tonic vergence (phoria) and the AC/A ratio. We have determined a fast and accurate method for evaluating both tonic accommodation (accommodative phoria) and vergence accommodation (CA/C ratio). In both procedures, the loop of accommodation was opened with a 0.2 cpd difference of Gaussian (DOG) target. This target was found to be incapable of stimulating any reflex accommodation, yet it is localized in space and can easily stimulate binocular fixation. Our results indicate that opening the loop of accommodation with a pinhole Maxwellian view or with a 0.2 cpd DOG produces similar response values for tonic accommodative aftereffects and vergence accommodation responses. The decay rate of tonic accommodative aftereffects as well as changes in the resting focus of accommodation caused by vergence accommodation (CA/C) can be measured clinically using dynamic retinoscopy in combination with the DOG target. Clinical values of the CA/C ratio obtained with these techniques were highly correlated (r = 0.92) with laboratory measures obtained with an objective infrared optometer and eye trac monitor.     

Near vision stress: vergence adaptation and accommodative fatigue

Changes in the visual system following prolonged near work were investigated. Fifteen young, normal subjects undertook a severe, two hour long, binocular near visual task at 20 cm without any breaks. Fusional stress was assessed by near 'phoria change. Refractive change was measured with an autorefractometer to investigate whether transient myopia occurred and its subsequent recovery. The near task caused vergence adaptation which was primarily due to the fusional stress of the task (accounting for 67% of its variance). The 'phoria change was to a lesser extent (40%) dependent on the accommodative "stress" of the task. Fatigue of the accommodative system resulted in increased accommodative innervation to maintain the same accurate response. Increased innervation can continue after the task on subsequent distance viewing, resulting in transient myopia (mean 0.29 DS). This transient myopia was found to be due to a transient regression of the far point towards the subject's tonic accommodation level. This can be accounted for by a shift of the tonic level as well as an increased bias towards the pre-task tonic level.     

The Glenn A. Fry award lecture: adaptive regulation of accommodative vergence and vergence accommodation

The tonic resting level of accommodation, measured with an objective infrared optometer in an open-loop state (pinhole pupil or empty field), was increased by more than 1.75 D from baseline measures of resting focus after adapting monocularly for 1 min to a 2 D minus lens. The accommodative aftereffect disappeared in darkness, but returned when a visible stimulus reappeared in the open-loop state. Stimulation of disparity vergence with 10 delta, while accommodation was in an open-loop state, also increased the resting focus of accommodation. Similarly, the tonic resting level of vergence became more esophoric after adapting for less than 1 min to base-out prism or to a minus lens presented while the vergence loop was opened. The effects of tonic accommodation on accommodative vergence and the effects of tonic vergence on vergence accommodation were investigated with the temporal frequency responses of the AC/A and CA/C ratios to sinusoidal variations in blur (2 D) and disparity (10 delta), respectively. Accommodative vergence was unresponsive to low temporal frequency sinusoidal variations in blur (less than 0.1 Hz). Similarly, vergence accommodation was unresponsive to low temporal frequency sinusoidal variations in disparity. However, accommodative vergence and vergence accommodation were responsive to higher temporal frequency stimuli (up to 0.5 Hz). When negative feedback to the stimulated system (accommodation or vergence) was cancelled electronically, the low temporal frequency response increased for the AC/A and CA/C ratios, respectively. There was also a nonlinear increase of both AC/A and CA/C ratios as stimulus amplitude increased. It is hypothesized that the nonlinearity resulted from limitations of adaptation to small stimuli. An inverse complementary relation is suggested between the amplitude of the AC/A ratio and adaptable tonic accommodation, and between the amplitude of the CA/C ratio and adaptable tonic vergence. This model predicts that in this complementary relation, adaptable tonic elements would sustain motor responses of accommodation and vergence that were initiated by phasic elements and cross-link interactions. It also predicts that the AC/A and CA/C ratios would decrease in time as dynamic control shifted from the phasic to the adaptable tonic control mechanisms of accommodation and vergence, respectively.     

Influence of accommodative and vergence adaptation on binocular motor disorders

Tait described four categories of binocular disorders including convergence excess, convergence insufficiency, divergence excess, and divergence insufficiency. These disorders are defined by the distance where the largest heterophoria occurs (distance or near), and the amplitude of the accommodative vergence ratio (AC/A). Insufficiency corresponds to a low AC/A ratio, whereas excess corresponds to a high AC/A. The magnitude of the AC/A ratio, which may be influenced by the adaptability of the accommodation and vergence systems, has been shown to be reciprocally related to adaptability of accommodation. Likewise, the degree of vergence accommodation has been shown to be related reciprocally to adaptability of vergence to prism. An imbalance of adaptability of accommodation and vergence systems produces abnormal cross-coupling between the two motor systems. When accommodation is more adaptable than vergence, the AC/A ratio is low and the CA/C ratio is high. Conversely, when vergence is more adaptable than accommodation, the AC/A ratio is high and the CA/C ratio is low. A method is reported for temporarily restoring moderate amplitudes of abnormal AC/A and CA/C ratios by reducing excessive adaptation with fatigue. Finally, new clinical procedures for measuring adaptation of accommodation and the CA/C ratio are presented. Taken together with current measures of vergence adaptation and AC/A ratio these procedures will permit a more complete evaluation of mutual interactions between accommodation and vergence in patients diagnosed as having excessive and insufficient vergence.     

The effect of vergence adaptation on convergent accommodation

This study investigates whether, during a sustained near-vision task, the convergent accommodation (CA) derived initially from the fast (reflex) vergence response is subsequently maintained by tonic (adaptive) vergence. CA was examined during the course of a 3 min near-vision task (viewing distance 33 cm) in 10 emmetropic subjects. Vergence was stimulated by the introduction of a 6 delta base-out prism before the right eye while the open-loop accommodative response of the left eye was measured at approximately 1 s intervals using an objective infra-red optometer. In a control condition the subject viewed the target through a plano lens (0 delta). The accommodation loop was opened by the subject viewing near-type through 0.5 mm diameter pinholes. Pre- and post-task measurement of heterophoria was made using a Maddox rod and prism bar. Regression of post-task heterophoria to the pre-task value indicated that adaptation to the vergence stimulus had occurred. However, there was no significant reduction in induced CA during the task. As the onset of adaptation does not produce any fall in CA, it is concluded that both reflex and adaptive vergence act as a stimulus to CA. This finding is discussed with regard to models of accommodation-vergence interaction.     

Stereopsis, accommodative and vergence facility: do they relate to dyslexia?

The relation between visual functions and reading performance has been the subject of conflicting opinion over the years. The purpose of this study is 2-fold: first, to examine factors other than visual acuity, i.e., stereopsis, accommodative facility and vergence facility, which might show a greater impact on reading achievement; and second, to utilize well defined dyslexic and normal controls to ensure that the reading deficits were not caused by overt neurological, psychological, educational, or environmental factors. Thirteen normal readers and 13 dyslexics were carefully matched by rigorous quantitative criteria. The performance of both groups on tests of visual acuity and stereopsis was similar. The dyslexic readers tended to show better accommodative facility. Dyslexics performed significantly worse than the matched normal readers on a test of vergence facility. These results, in agreement with those reported by other studies, indicate that less efficient dynamic vergence facility may contribute to reading impairment, unlike other static functions such as visual acuity and stereopsis. It may be that the vergence problems of the dyslexics are related to sequential oculo-motor abnormalities. The dyslexics' vergence problems may also be partly responsible for their large number of small eye movements.     

Fixation disparity,accommodation, dark vergence and dark focus during inclined gaze*

We investigated several oculomotor functions at different angles of vertical inclination of the gaze direction from 15 deg upwards to 45 deg downwards. The mean accommodative resting state (measured in a dark visual field) increased when the eyes or the head were declined from 0 to 45 deg. Fixation disparity (the vergence error in minutes of arc relative to the principle visual directions) became more eso when a fusion target at a viewing distance of 40 cm was lowered: declining the gaze by 45 deg changed mean fixation disparity by 1.8 min arc with eye inclination (keeping the head upright), and by 0.9 min arc with head inclination (with eye position unchanged relative to the head). When the eyes were lowered, the individual rate of eso change in fixation disparity was correlated with the amount of the subjects’ near shifts in the resting position of vergence, measured in darkness. Significant test-retest correlations between repeated measurements showed that the effects of eye inclination on vergence varied in a reproducible way among individuals with good binocular vision.     

The source of disparity vergence innervation determines prism adaptation

A physiological model of prism adaptation argues that adaptation magnitude and rate are functions of the magnitude of reflex vergence innervation. It has also been shown that there is reduced prism adaptation magnitude for a given disparity stimulus where only peripheral sensory fusion is present (the 'eccentricity effect'). This study attempted to determine whether the eccentricity effect is attributable to reduced reflex vergence innervation in peripheral fusion. Experiments were run in a Maxwellian view haploscope. Convergence and divergence adaptation to 6 Δ disparity stimuli were quantified for seven binocularly normal subjects using subjective heterophoria measurements. Vergence response during central or peripheral fusion was quantified objectively by infrared oculography. Six of seven subjects revealed an eccentricity effect. However, in three of seven subjects the eccentricity effect was not predictable from the manifest vergence response. The results suggest that the source of reflex vergence innervation affects prism adaptation. A model is proposed whereby different sources of reflex disparity vergence innervation stimulate prism adaptation by way of separate neurological pathways of differing responsiveness.     

Short-term predictive changes in the dynamics of disparity vergence eye movements

Repetitive stimulation of the disparity vergence system to large convergent step stimuli has been shown to increase the dynamics of subsequent responses to smaller step stimuli. Here we show that decreases in the dynamics of both disparity convergence and divergence eye movements can be induced using a frequently occurring small amplitude conditioning stimulus to modify responses to a larger, occasionally presented test stimulus. In one experiment, a simple conditioning stimulus consisting of repetitive 1 degrees step stimuli was used to modify the dynamic vergence response to an occasional 4 degrees step test stimulus. An experimental trial consisted of three phases: baseline, conditioning, and recovery. The baseline and recovery phases used only the 4 degrees test stimuli. The dynamic characteristics of the responses to test stimuli were quantified by measuring the magnitude of the peak velocity. A statistically significant change was observed between the dynamics of conditioned responses compared to baseline and recovery responses indicting modification by the conditioning stimuli. During recovery, the response dynamics returned to levels near baseline levels showing that the decrease in response dynamics was caused by the conditioning stimulus, not fatigue. Another experiment showed that the response dynamics to large stimuli could be decreased whereas the dynamics of small stimuli could be increased by the same intermediate conditioning stimulus. Other experiments suggest that the modifications are due to a predictive mechanism. The results indicate that the dynamics of disparity vergence eye movements are malleable and depend to some extent on the amplitude of preceding stimuli.     

Changes in dynamics of accommodation after accommodative facility training in myopes and emmetropes

This study evaluates the effect of accommodative facility training in myopes and emmetropes. Monocular accommodative facility was measured in nine myopes and nine emmetropes for distance and near. Subjective facility was recorded with automated flippers and objective measurements were simultaneously taken with a PowerRefractor. Accommodative facility training (a sequence of 5 min monocular right eye, 5 min monocular left eye, 5 min binocular) was given on three consecutive days and facility was re-assessed on the fifth day. The results showed that training improved the facility rate in both groups. The improvement in facility rates were linked to the time constants and peak velocity of accommodation. Some changes in amplitude seen in emmetropes indicate an improvement in facility rate at the expense of an accurate accommodation response.     

Adaptation model of accommodation and vergence

Both accommodation and vergence have been shown to exhibit adaptation after extended near viewing. Normally, when the stimulus to accommodation is removed, the accommodation system returns rapidly towards its tonic position. However, if the stimulus is removed after an extended focusing effort, the decay is much slower. A similar effect can be observed in the vergence system. After prolonged wearing of horizontal prisms, blockage of one eye results in a much slower decay of the vergence output towards its tonic value. No previous models have been shown to simulate quantitatively these effects. An interactive dual-feedback model of accommodation and vergence was developed to simulate the adaptive behaviour found experimentally. The unique feature of the model is that the output of each controller drives a dynamic adaptive component whose output governs the time constant of the controller. The model was able to simulate the rapid and slow decays following short and long viewing intervals in each of the accommodative and vergence systems. It also simulated adaptation during alternate binocular and monocular viewing under the accommodation closed-loop condition. Thus, this model can serve as the basis for detailed quantitative evaluation of adaptive behaviour in the accommodation and vergence systems.     

Tonic accommodation, tonic vergence and surround propinquity

Previous studies have typically assessed tonic accommodation (TA) and tonic vergence (TV) by placing subjects in total darkness. However, a recent investigation demonstrated that even under such apparently stimulus-free conditions, subjects' awareness of the proximity of the adjacent surroundings and overall room topography (i.e. surround propinquity) may still influence the accommodative response. Accordingly, the aim of the present study was to measure TA and TV while subjects ( n = 34) viewed an illuminated distant target (viewing distance = 6 m) to minimize this propinquity effect. TA was measured using an objective, opentield. infrared optometer under two conditions: first, while viewing the distant target monocularly through a 0.5 mm pinhole, and second in total darkness. Additionally, TV was assessed by determining the heterophoria subjectively while subjects viewed the distant target biocularly through 0.5 mm pinholes. The mean level of TA using the pinhole technique (mean = 0.28 D) was significantly lower than that observed in total darkness (mean = 0.60 D). Furthermore, a significant positive correlation ( r = 0.86) was found when comparing the difference between the two TA measurements with the level obtained in total darkness. Those subjects having apparently high levels of TA in darkness exhibited the largest propinquity effect. Thus measurements of accommodation recorded in total darkness are likely to have overestimated both the magnitude and normal range of TA. The mean level of TV was 0.58 metre angle. No significant correlation was observed between TV and either of the two TA measurements. Therefore more accurate assessments of both TA and TV may be obtained by having subjects view distant targets while placing both the accommodation and vergence systems under open-loop conditions.     

Closed-loop and open-loop accommodative vergence eye movements

We examined accommodative vergence eye movements under conditions in which feedback about retinal-image slip was and was not present (i.e. closed-loop and open-loop conditions). We found that (a) in both conditions the two eyes started to move at the same time; (b) in the open-loop condition, vergence continued in both eyes; and (c) in the closed-loop condition, vergence continued in the occluded eye only, and the magnitude and velocity exceeded that of the occluded eye in the open-loop condition by a factor of two.