Therapy for Asthenopia in Cases of Convergence Insufficiency Hiroko TAKASAKI, C.O.J., Nobuko INAGAMI, C.O.J., and Kayoko TAKENAWA, C.O.J.. Orthoptic c

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1 Therapy for Asthenopia in Cases of Convergence Insufficiency Hiroko TAKASAKI, C.O.J., Nobuko INAGAMI, C.O.J., and Kayoko TAKENAWA, C.O.J.. Orthoptic clinic, Department of Ophthalmology, (Director: Prof Dr. N. Matsuo) Okayama University Medical School, Okayama-shi The usefullness of therapeutic methods for asthenopic problems was studied in nineteen cases of convergence insufficiency. In all cases it was found that amplitude of fusinal convergence, as well as AC/A ratio were reduced. The first therapeutic method was reading glasses. These were prescribed in five patients, whose power of accommodation and the AC/A ratio had been decreased drastically compared to that of normal subjects. The second was prism glasses. It was taken in nine patients, whose relative fusional convergence were more significantly reduced than the AC/A ratio. The power of prisms was equal to half of their deviations at near distance. The last was surgical treatment. The bimedial resection was done in five patients, who had larger angle of exophoria at near distance than that of groups A and B. With these methods, fusional amplitude, as well as AC/A ratio had been improved in all cases and consequently asthenopia disappeared. From this study, it is difficult to draw conclusion, whether deficiency of accommodative convergence or decrease of fusional convergence may play an important role in asthenopia. We consider that the decrease of accommodative convergence causes asthenopia, in which near problems could be solved, according as the AC/A ratio normalizes. Key words: asthenopia, convergence insufficiency, AC/A ratio, fusional amplitude, accommodation.

3 Fig. 1 The N.P.A. in each eye were compared to age in normals (Duane, 1922) 4), before and after treatment. The direction of arrows showed the value of improvement. Statistical improvement of N.P.A. was gained in every method of treatment. Fig. 2 The comparison of N.P.C. before and after treatment. The direction of arrows showed the value of improvement. All patients got improved.

4 Fig. 3 Relative fusional amplitude were examined before and after treatment. Before treatment, the range of fusional convergence was especially reduced in all patients comparing with normals. After treatment the fusional range were improved in all methods of treatment, but not every patient regained that of normals. Fig. 4 The AC/A ratio. The direction of arrows showed the value of improvement. Every methods of treatment was effective, but most one was group C.

5 D.E.: dominant eye non D.E.: non dominant eye N.P.A.: near point of accommodation N.P.C.: near point of convergence *:P<0.05 1) Burian, H.M. and von Noorden, G.K.: Binocular vision and ocular motility 3rd Ed.,: , C.V. Mosby, St Louis, ) Simpson, G.V.: Convergence insufficiency, Medical management. Am. Orthopt. J. 3; 18-22, ) von Noorden, G.K., Brown, D.J. and Praks. M.: Assosiated convergence and accommo- insufficiency. Doc. Ophthalmol. dation 34: , ) Duane, A.: Studies in monocular and binocular accommodation with their clinical applications. Am. J. Ophthalmol. 5; 865, 1922.

Among 83 patients who had undergone the operation for intermittent exotropia, 15 patients had esotropia persisting longer than one month after the ope

Among 83 patients who had undergone the operation for intermittent exotropia, 15 patients had esotropia persisting longer than one month after the operation. We followed up these 15 patients and analyzed