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Accommodation/Vergence Dysfunction Cheat Sheet by

Accomm­odative Insuff­iciency

Low accomm­odative amplitude
Low AC/A
High Lag
Fails -2.00 (OD, OS, OU)
Eso at near
*Ill-s­ust­ained accomm. is milder case of AI

Accomm­odative Excess

High AC/A
Low Lag (or lead)
Fails +2.00 (OD, OS, OU)
Eso at near
*Accomm. Spasm is severe form of AE - spasm of near triad

Accomm­odative Infacility

Fails/­dif­ficulty +2.00 & -2.00 (OD, OS, OU)

Basic Eso

Eso similar dist & near
Reduced BI (dist & near)
Eso fd (dist & near)
Normal AC/A
Large Lag
Fail -2.00 OU
high tonic vergence

Conver­gence Excess

Near Eso > Dist Eso high tonic vergence
^Near Eso, Dist Ortho normal tonic vergence
Reduced NBI (DBI may be reduced), BI facility (near)
Eso fd
Moderate hyperopia
High AC/A
High Lag
Diffic­ult­y/fails -2.00 OU

Conver­gence Insuff­iciency

Near Exo > Dist Exo low tonic vergence
Dist Ortho, Near Exo normal tonic vergence
Reduced NPC
Reduced NBO and BO facility
Low AC/A
Small lag (or plano)
Difficulty +2.00 OU
Exo fd

Pseudo Conver­gence Insuff­iciency

Near Exo > Dist Exo
Receded NPC (noncom. & accom. target about the same)
Reduced PFV (or BO) at near
Reduced PRA
Fails -2.00 OU, Low OD, OS
Low amplitude
Large lag (>+­1.00)
Addi­tional plus at near may reduced exo &/or improve NPC
Really an underlying accom. insuff­ici­ency

Divergence Insuff­iciency

Dist Eso > Near Eso high tonic vergence
Reduced DBI, BI facility (dist)
Eso fd at distance
Low AC/A

Divergence Excess

Dist Exo > Near Exo low tonic vergence (tropia or phoria)
Normal or limited DBI (adequate DBO)
High AC/A

Basic Exophoria

Exo similar dist & near
Reduced BO (dist & near)
Possibly receded NPC
Redced BO facility (dist & near)
Exo fd (dist & near)
Normal AC/A
Small Lag
Fail +2.00 OU
low tonic vergence

Fusional Vergence Dysfun­ction (Bino Instab­ility)

Reduced BI & BO dist and near
Reduced vergence facility (BO &/or BI at DV &/or NV)
NRA & PRA may be low
May fail/d­iff­iculty binocular accomm. facility
Normal AC/A
normal tonic vergence

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