• American Optometric Association. Care of the patient with accommodative and vergence dysfunction. 2nd ed. St. Louis (MO): American Optometric Association; 1998. 89 p. (Optometric clinical practice guideline; no. 18). [160 references]

This is the current release of the guideline.

According to the guideline developer, this guideline has been reviewed on a biannual basis and is considered to be current. This review process involves updated literature searches of electronic databases and expert panel review of new evidence that has emerged since the original publication date.

Accommodative or vergence dysfunction

Diagnosis
Evaluation
Management
Treatment

Optometry

Health Plans
Optometrists

• To identify patients at risk for developing accommodative or vergence dysfunction
• To accurately diagnose accommodative and vergence anomalies
• To improve the quality of care rendered to patients with accommodative or vergence dysfunction
• To minimize the adverse effects of accommodative or vergence dysfunction and enhance the quality of life of patients having these disorders
• To inform and educate other health care practitioners, including primary care physicians, teachers, parents, and patients about the visual complications of accommodative or vergence dysfunction and the availability of treatment.

Patients of all ages with accommodative and vergence dysfunction

Diagnosis

1. Patient History
2. Ocular Examination
   • Visual Acuity
   • Refraction
   • Ocular Motility and Alignment
   • Near Point of Convergence
   • Near Fusional Vergence Amplitudes
   • Relative Accommodation Measurements
   • Accommodative Amplitude and Facility
   • Stereopsis
   • Ocular Health Assessment and Systemic Health Screening
3. Supplemental Tests
   • Accommodative Convergence/Accommodation Ratio
   • Fixation Disparity/Associated Phoria
   • Distance Fusional Vergence Amplitudes
   • Vergence Facility
   • Accommodative Lag
4. Assessment
   • Graphical Analysis
   • Zones of Comfort
   • Comparison to Expected Values
   • Fixation Disparity and Vergence Adaptation
   • Comparison of Methods of Analysis

Treatment

1. Optical Correction
2. Vision Therapy
3. Lens and Prism Therapy
4. Medical (Pharmaceutical) Treatment
5. Surgery

Not stated

Hand-searches of Published Literature (Primary Sources)
Searches of Electronic Databases

The guideline developer performed literature searches using the National Library of Medicine's Medline database and the VisionNet database.

Not stated

Expert Consensus (Committee)

Not applicable

Review

Not applicable

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Internal Peer Review

The Reference Guide for Clinicians was reviewed by the American Optometric Association (AOA) Clinical Guidelines Coordinating Committee and approved by the AOA Board of Trustees.

Diagnosis of Accommodative and Vergence Dysfunction

The evaluation of a patient with accommodative and vergence dysfunction may include, but is not limited to, the following areas. The examination components described are not intended to be all inclusive. Professional judgment and the individual patient's symptoms and findings have a significant impact on the nature, extent, and course of the services provided. The potential components of the diagnostic evaluation for accommodative and vergence dysfunction include the following areas:

1. Patient history
2. Ocular examination
3. Visual acuity
4. Refraction
5. Ocular motility and alignment
6. Near point of convergence
7. Near fusional vergence amplitudes
8. Relative accommodation measurements
9. Accommodative amplitude and facility
10. Stereopsis
11. Ocular health assessment and systemic health screening
12. Supplemental tests
    1. AC/A ratio
    2. Fixation disparity/associated phoria
    3. Distance fusional vergence amplitudes
    4. Vergence facility
    5. Accommodative lag

Management of Accommodative and Vergence Dysfunction

Management of the patient with an accommodative or vergence dysfunction is based on such interpretation and analysis of the examination results.

The general goals for treating accommodative and/or vergence dysfunction are:

• To assist the patient to function efficiently in school performance, at work, and/or in athletic activities
• To relieve ocular, physical, and psychological symptoms associated with these disorders.

The frequency and composition of evaluation and management visits for accommodative or vergence dysfunction is summarized in the table, below.

Frequency and Composition of Evaluation and Management Visits for Accommodative or Vergence Dysfunction

Note: VT = vision therapy
MRI = magnetic resonance imaging
* See original guideline document for other management strategies

An algorithm is provided for Optometric Management of the Patient with Accommodative Dysfunction.

The type of supporting evidence is not specifically stated for each recommendation.

Most accommodative and vergence dysfunction responds to the appropriate use of lenses, prisms, or vision therapy. It is medically necessary for the optometrist to diagnose the condition accurately, discuss the diagnosis and the risks and potential benefits of existing treatment options with the patient, and initiate treatment when appropriate. Treatment, including lenses, prisms and vision therapy, is not age restricted. Vision therapy can be given at any age. In some cases, the best treatment includes a combination of lenses, prisms, and/or vision therapy. Proper treatment usually results in rapid, cost-effective, and permanent improvement in visual skills.

Not stated

Clinicians should not rely on this Clinical Guideline alone for patient care and management. Please refer to the references and other sources listed in the original guideline for a more detailed analysis and discussion of research and patient care information.

An implementation strategy was not provided.

Getting Better
Staying Healthy

Effectiveness
Patient-centeredness

• American Optometric Association. Care of the patient with accommodative and vergence dysfunction. 2nd ed. St. Louis (MO): American Optometric Association; 1998. 89 p. (Optometric clinical practice guideline; no. 18). [160 references]

Not applicable: The guideline was not adapted from another source.

1998 (reviewed 2006)

American Optometric Association - Professional Association

Funding was provided by the Vision Service Plan (Rancho Cordova, California) and its subsidiary Altair Eyewear (Rancho Cordova, California)

American Optometric Association Consensus Panel on Care of the Patient with Accommodative or Vergence Dysfunction

Members: Jeffrey S. Cooper, M.S., O.D. (Principal Author); Carole R. Burns, O.D.; Susan A. Cotter, O.D.; Kent M. Daum, O.D., Ph.D.; John R. Griffin, M.S., O.D.; Mitchell M. Scheiman, O.D.

AOA Clinical Guidelines Coordinating Committee Members: John F. Amos, O.D., M.S. (Chair); Kerry L. Beebe, O.D.; Jerry Cavallerano, O.D., Ph.D.; John Lahr, O.D.; Richard L. Wallingford, Jr., O.D.

Not stated

This is the current release of the guideline.

According to the guideline developer, this guideline has been reviewed on a biannual basis and is considered to be current. This review process involves updated literature searches of electronic databases and expert panel review of new evidence that has emerged since the original publication date.

None available

This summary was completed by ECRI on December 1, 1999. The information was verified by the guideline developer on January 31, 2000.