# accommodative convergence

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## ac·com·mo·da·tive con·ver·gence

the meter angle of convergence expressed in diopters; equal to the product of the meter angles of convergence multiplied by the interpupillary distance measured in centimeters.

## AC/A ratio

Ratio of the accommodative convergence AC (in prism dioptres) to the stimulus to accommodation A (in dioptres). The most common method of determining this ratio is by the gradient method (or gradient test) in which the phoria at near is measured after changing the accommodation with a spherical lens (usually +1.00 D or −1.00 D) placed in front of the two eyes. It is expressed as
AC/A = (α − α′)/F
where α is the phoria at near, and α′ is the phoria at the same distance but through a lens of power F. The deviation is measured in prism dioptres, with + for esodeviation and − for exodeviation. Example: if the initial phoria is 4 Χ exo and 8 Χ exo when a lens of +1.00 D is placed in front of the eyes, the AC/A ratio is equal to
[−4 − (−8)]/1 = 4 Χ/D
The average AC/A ratio is about 4 in young adults and tends to decline slightly with age. The gradient is not affected by proximal convergence, as the target distance and size are relatively constant. Syn. gradient.Another method of determining the AC/A ratio (often called the heterophoria method) compares the phoria measured at distance and at near. It is expressed as
AC/A = PD + ((N − D)/K)
where PD is the interpupillary distance in cm, N the deviation at near, D the deviation at distance and K the near fixation distance in dioptres. Example: A patient has a PD of 70 mm, a distance phoria of 4 Χ eso and a near phoria of 8 Χ exo at 33.3 cm from the eyes, the AC/A ratio is equal to
7.0 + ([−8 − (+4)]/3) = 3 Χ/D
See accommodative convergence; proximal convergence; prism dioptre.
References in periodicals archive ?
Refractive accommodative esotropia (RAE) includes accommodative convergence, uncorrected hyperopia and inadequate fusional divergence.
Of the subjects, 50 percent exhibited reduced values for relative accommodation (positive relative accommodation [PRA] and negative relative accommodation [NRA]) and 50 percent had an abnormal accommodative convergence to accommodation ratio.
18) Accommodative convergence has been shown to have no effect on nystagmus, hence spherical manipulation of spectacle prescriptions does not improve nystagmus.
Myopes tend to show more enhanced accommodative convergence (esophoria and elevated AC/ A ratios), along with insufficient accommodative responses (accommodative lag) compared to their emmetropic counterparts.
d Decreased accommodative convergence when using the reading spectacles
Accommodative responses, including both monocular and binocular accommodative amplitude, accommodative convergence to accommodation ratio, and negative and positive relative accommodation, were reduced in the TBI population compared with normative values.
b) Prescribe negative lenses to induce accommodative convergence
This is when a patient who may not have a significant refractive error is given negative lenses to induce accommodative convergence, hence reducing an exophoric deviation.

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