This document presents a case study of a 21-year-old female student complaining of tearing and eyestrain with prolonged near work. Her ocular examination results are within normal limits except for a low accommodative facility and binocular vision dysfunction. The patient is diagnosed with fusional vergence dysfunction based on her symptoms and examination findings. She is prescribed daily jump exercises for one month to treat her condition.

1. CASE PRESENTATION
MIKAH TCHALE

2. ACKNOWLEDGEMENTS
MR SYMON CHIKUMBA, optometrist
MR JALLIFF CHITSEKO, optometrist

3. PATIENT’S PARTICULARS
NAME: RT
AGE: 21
SEX: F
LOCATION: AREA 1B
OCCUPATION: SECONDARY SCHOOL STUDENT

4. CASE HISTORY
CHIEF COMPLAINT
Tearing and eyestrain with prolonged near work
OCULAR Hx: has an ocular allergy and
currently on treatment ie sodium
cromoglycate

5. MEDICAL Hx: N/S
FAMILY Hx: N/S

6. OCULAR EXAMINATION
VISUAL ACUITY
i. DISTANCE
OD: 6/6
OS: 6/6
ii. NEAR
 OD:N5
 OS:N5

7. ANTERIOR SEGMENT
OD OS
NAD LIDS NAD
PAPIILLAE CONJ PAPILLAE
CLEAR CORNEA CLEAR
RRLA PUPILS RRLA
DEEP & QUIET AC DEEP & QUIET
CLEAR LENS CLEAR

8. DIRECT OPTHALMOSCOPY
OD OS
0.3 CD RATIO 0.3
HEALTHY OPTIC DISC HEALTHY
NAD MACULA NAD
2:3 AV RATIO 2:3
WNL PERIPHERY WNL

9. NON CYCLOPLEGIC REFRACTION
OD: +0.25D….6/6
OS: +0.25D….6/6
The patient was sent home and told to come
the next day for binocular vision assessment
and cycloplegic refraction

10. OCULAR MOTILITY: SAFE
COVER TEST
i. DISTANCE: 4∆ XOP
ii. NEAR: 6∆ XOP
 NPC: 5/8 cm
 IPD: 62mm

11.  CONFRONTATIONAL VISUAL FIELDS
(PERIPHERAL FINGER COUNTING AND FACIAL
AMSLER)
FULL (ou)

12. AMPLITUDE OF ACCOMMODATION
OD: 4.4D
OS:4.5D
OU:5.0D
NRA: +0.50
PRA: -1.00

13. DYNAMIC RETINOSCOPY
OD: +0.75
OS: +0.75
ACCOMMODATIVE FACILITY
OD:2cpm
OS: 2cpm
OU: 1cpm

14. CYCLOPLEGIC REFRACTION
OD:+0.25…6/6
OS: PLANO…6/6
CALCULATED AC/A RATIO
IPD (cm) + NFD (m) [Hn-Hf]
5.4:1

15. AC/A ratio is a key element in the appropriate
management
High AC/A ratio→ plus lenses
Low/normal AC/A ratio→ prisms/vision therapy

16. EXPECTED FINDINGS
1) NPC
 Break point: 5cm±2.5
 Recovery: 7cm ±3.0
2) Accommodative facility
 Children (monocular| binocular)
 6yrs old: 5.5cpm±2.5 | 3cpm±2.5
 7yrs old: 6.5cpm ±2.0 | 3.5cpm±2.5
 8-12yrs old: 7cpm±2.5 | 5cpm±2.5

17.  Adults
13-30yrs old: 11cpm±5 | 10cpm±5.0
30-40 yrs: not quantified
4) Relative accommodation
 NRA: +2.00D±0.50
 PRA: -2.73D±1.00
5) MEM: +0.50±0.25
6) AC/A Ratio: 4:1±2

18. DIFFERENTIALS
Basic exophoria
Accommodation insufficiency
Fusional Vergence dysfunction

19. FINAL DIAGNOSIS
FUSIONAL VERGENCE DYSFUNCTION

20. TREATMENT
Jump exercises 3x/day for 1 month
Review after 1 month

21. LITERATURE REVIEW
FUSIONAL VERGENCE DYSFUNCTION
SYMPTOMS
Eyestrain and headaches after relatively short periods
of near work
Inability to concentrate
Excessive tearing
Blurred vision
Loss of comprehension over time

22. ETIOLOGY AND PREVALENCE
Etiology is not known
Prevalence is not clearly defined in literature
Some researchers reported a prevalence of 0.6% in
children of 6-18 yrs; 1.6% in university students

23. SIGNS
Normal AC/A ratio
Phoria within expected values at distance and near
Binocular instability
Do not have a high degree of RE
Low NRA and PRA (these can be considered an indirect
measure of fusional vergence)
Low accommodative facility

24. TREATMENT
Vision therapy
Plus lenses (increase integration of accommodation
and vergences that then facilitates stable binocular
function)

25. VISION THERAPY FOR FVD
i. 1st PHASE: Normalise accommodative and
vergence amplitudes
ii. 2nd PHASE: Increase the speed of response to
accommodative and vergence stimuli
iii. 3rd PHASE: Utilise step &/or jump vergence
stimuli
iv. 4th PHASE: Integrate vergence and
accommodation to automate both
accommodative and vergence response