THE INFLUENCE OF REFRACTIVE CORRECTION UPON DISORDERS OF VERGENCE ANDACCOMMODATION

Clinical care routinely includes prescription of lenses that compensat e for the distance refractive error. Indeed, refractive correction is so commonly prescribed that we often neglect its potential effects on disorders of binocular vision. We report improvement of binocular func tion that resulted 1 or more months after prescription of an initial s pectacle correction for 143 nonstrabismic patients who had a refractiv e error and either a vergence anomaly (28%), an accommodative anomaly (8%), or both (64%). Refractive correction was estimated objectively w ith an autorefractor and subjectively refined without cycloplegia. Mos t corrections were low to moderate in power, essentially following Ori nda Study guidelines. Recovery of normal vergence and accommodative fu nction varied according to refractive error type (79% of hyperopic ast igmats recovered; 20% of myopes recovered), direction of astigmatic ax es (67% recovered who had against-the-rule; 45% with with-the-rule rec overed), age (63% below age 12 years recovered; 41% older than age 13 years recovered), and vergence anomaly (67% of patients with fusional vergence dysfunction recovered; 38% of those with basic exophoria reco vered). These results suggest that improvement in acuity is not the on ly reason for prescription of a refractive correction-prescription of even small corrections should be considered as these can dramatically improve vergence and accommodative function for many patients.