An Unexpected Role for Normal Accommodative Vergence in Strabismus and Amblyopia

ABSTRACT Accommodative vergence was measured using the Müller experimental paradigm in which target movement along the line of sight of the viewing eye results in large movement of the fellow (covered) eye. Our paper demonstrates an unexpected predominance of accommodative vergence over disparity vergence in patients with constant strabismus amblyopia, intermittent strabismus, and amblyopia without strabismus. Comparison of accommodative vergence responses in these patients with responses from normal subjects using symmetrical and asymmetrical targets under binocular and monocular conditions established the normal character of the patients' accommodative vergence and the absence of disparity vergence in most of them. The intermittent absence of disparity vergence in certain of our patients—some with surgically corrected strabismus, some with moderate amblyopia, and some with amblyopia treated with orthoptics—raises questions of clinical and neurophysiological interest. Preliminary results on the effects of amblyopia on accommodative responses are also presented.