Mindanao Medical Foundation College
College of Optometry
Case report on: A comparative study of an emmetropic patient to a patient with Accommodative and Convergence Insufficiency
This case study aims to compare an emmetropic patient to a patient with accommodative insufficiency and convergence insufficiency based from the results of Binocular vision examination and Preliminary Optometric procedures.
Keywords: emmetropia, accommodative insufficiency, convergence insufficiency
Emmetropia is a normal refractive state of the eye, in which, with accommodation relaxed, parallel rays of light will converge exactly to a sharp focus on the retina. . Accommodative insufficiency (AI) is a condition in which people find it difficult to focus on near objects, to an extent which is unusually poor for their age group. The condition can occur in young people and children, and it is not caused by a problem with the lens of the eye. This means that accommodative insufficiency is different from the disorder known as presbyopia, commonly seen in people over the age of 40. In presbyopia, the lens loses its elasticity and its ability to adapt for near focusing. People with accommodative insufficiency typically experience eye fatigue when carrying out close work for a sustained period.  Common accommodative insufficiency symptoms include general tiredness when reading, headaches, blurred vision and eye strain. Loss of concentration and even motion sickness may occur. Individuals who spend a lot of time using computers, reading or carrying out detailed, close work are more prone to developing the symptoms associated with AI. Children with accommodative insufficiency may struggle with school work and may try to avoid reading whenever possible due to the discomfort they experience. Sometimes, children will assume that their experience is normal, with the result that their symptoms do not come to light until they reach adulthood.  The condition is sometimes associated with another disorder known as convergence insufficiency (CI). In convergence insufficiency, the eyes do not move inward effectively to allow accurate focusing on something near. This causes what is known as asthenopia, a situation in which people experience discomfort and difficulties performing the kinds of tasks where close focusing is necessary.  Convergence insufficiency is a common condition that is characterized by a patient 's inability to maintain proper binocular eye alignment on objects as they approach from distance to near. There is typically an exophoria or intermittent exotropia at near, a receded near point of convergence, reduced positive fusional convergence amplitudes, and a low accommodation convergence/accommodation (AC/A) ratio. The symptoms associated with convergence insufficiency vary from mild to severe, but they are often extremely troublesome for patients with this condition, especially when associated with a small angle exotropia at the near working distance causing binocular diplopia. Convergence Insufficiency (CI) is the leading cause of eyestrain, blurred vision, double vision (diplopia), and/or headaches.  CI is very common in school children. 3%-11% may be affected and many of are unknown as well. CI is normally misdiagnosed for someone having adhd which is attention deficit hypertension disorder. Students who has this, normally has poor grades, the reason is their inability to focus in school. Many of homework require near reading and often times, students get frustrated and can not concentrate or read the words. 
Case report :
The case was all about a 2 young male individuals: First is a 16 year old male student with old Rx complaining of blurring of vision at far and near, eyeache, redness and diplopia after prolonged close work. The patient has undergone entropion surgery for his right eye and has a former case of glaucoma and his right eye...
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