A Case of Accommodative Insufficiency with Vergence Disorder in a 17-Year Old Student

Abstract

Accommodation Insufficiency (AI) is a condition in which a patient has an inability to focus or maintain focus at near. AI is mostly observed to occur with a vergence problem especially convergence insufficiency due to the close link between accommodation and convergence system of the eyes. Common symptoms seen in AI are diplopia, asthenopia and difficulty reading at near. Several management options are available including plus lenses for near work, optometric vision therapy and monitoring. A 17-year-old lady presented to the eye department with eyestrains, frontal headache, blurry vision at near with reading difficulties. According her, this problem started in 2018. Visual acuity (VA) for both distance and near was measured. Detailed anterior and posterior segments assessment revealed no anomalies, but binocular assessment showed reduced Amplitude of Accommodation (AOA), increased lag of accommodation, reduced Monocular Accommodative Facility (MAF) and Binocular Accommodative Facility (BAF), reduced Positive Relative Accommodation (PRA) and receded Near Point of Convergence (NPC). Based on the patient's complaint and what the assessment revealed, accommodative insufficiency with vergence disorder was made. Vision therapy and distance optical correction were prescribed to manage the problem. Accommodative Insufficiency can be treated effectively by an in-office/home-based program. The repetition of appropriate optometric vision therapy procedures at home will help resolve a patient's maladaptive visual condition over time.