4/23/2017

Normally when a target

moves from far-to-near,
our vision benefits E
from linking
accommodation and
convergence.

The Near Triad

AC/A AND CA/C
E E
JEN SI MONSON, OD, FCOVD EE
THE NEAR TRIAD 1 THE NEAR TRIAD 2

1.Our eyes accommodate to see clearly at near. The amount of accommodative convergence (AC)
2. The accommodation also drives convergence to see single driven by the amount of accommodation (A) is
vision at near. called the AC/A ratio.
E E

E E E E
EEE E
THE NEAR TRIAD 3 THE NEAR TRIAD 4

1.Accommodation 1.Accommodation

E E E E

THE NEAR TRIAD 5 THE NEAR TRIAD 6

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1.Accommodation 1.Accommodation
2.Convergence 2.Convergence
E

E E
EE
THE NEAR TRIAD 7 THE NEAR TRIAD 8

1.Accommodation
2.Convergence
E

E E 1.Accommodation
EE 2.Convergence
3.Pupil Constriction
THE NEAR TRIAD 9 THE NEAR TRIAD 10

How does the visual system respond

to a minus lens?
All three E
neuro-
muscular
responses
occur with
a stimulus
moving
from far to E E
near.

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Step 1: Minus lenses

Minus lenses stimulate accommodation. Through the AC/A, the
eyes reflexively converge. This creates the situation where our eyes cause defocus, which
must adjust by diverging to keep the image clear and single. stimulates E
accommodation.
E

E E E E
EE
THE NEAR TRIAD 13 THE NEAR TRIAD 14

When the eyes Step 2: Convergence is

accommodate to stimulated when the
match the lens E eyes accommodate. E
power, the target This creates double
becomes clear. vision.

E E E E

EE
THE NEAR TRIAD 15 THE NEAR TRIAD 16

Step 3: Fusional
Divergence realigns
the eyes to the
image. Now vision is
clear and single.
Step 1: To clear a plus
E E lens, the eyes must
relax accommodation.

E E E E
EE
EE
THE NEAR TRIAD 17 THE NEAR TRIAD 18

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Step 2: This
When the eyes adjust relaxation of focus
E to match the lens also causes a E
power, the target relaxation of
becomes clear. vergence – the
eyes diverge.

E E E E

EE
THE NEAR TRIAD 19 THE NEAR TRIAD 20

Step 3: We must 1.Accommodation

E use fusional 2.Convergence
convergence to 3.Pupil Constriction
create single
vision.

E E

EE
THE NEAR TRIAD 21 THE NEAR TRIAD 22

The work of Linda Sanet, COVT: The work of Linda Sanet, COVT:

THE NEAR TRIAD 23 THE NEAR TRIAD 24

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Stimulating
Accommodation
Stimulating more makes the
Accommodation also eyes converge more.
stimulates This is because when
Convergence. an object moves
closer, the eye has to
This is called the both focus more and
E “AC/A” E turn in more.

The AC/A is the

amount of
Accommodative
Convergence per unit
of Accommodation.

THE NEAR TRIAD 25 THE NEAR TRIAD 26

E
E

E E E E
EE EE
THE NEAR TRIAD 27 THE NEAR TRIAD 28

Stimulating Convergence
more makes the eyes When an object
accommodate more. This is moves from near
because when an object to far, the
moves closer, the eye has to E response is
both turn in more and focus relaxed
more. accommodation,
divergence and
pupil dilation.

E E
EEE
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A plus lens will

stimulate relaxation
When we add a
of accommodation
lens or prism in
and divergence
front of the eye,
through the AC/A.
we still respond
We must then use
as if the target
fusional convergence
moved closer or
to see single vision.
further away. We
must then make
an adjustment to
see clear and
single vision.

THE NEAR TRIAD 31 THE NEAR TRIAD 32

A minus lens A base-in (apex-

stimulates out) prism
accommodation. stimulates
Through the AC/A, divergence.
the eye also Through the CA/C,
converges. We must the eye also relaxes
then adjust by focus. We must
fusional divergence then adjust by
to maintain single focusing to
vision. maintain clear
5 vision.
BI

THE NEAR TRIAD 33 THE NEAR TRIAD 34

A base-out (apex-in)
prism stimulates The more you accommodate (focus), the more the
convergence.
Through the CA/C, eyes converge. The more you converge, the more
5 the eye also your eyes focus.
BO accommodates. We
must then adjust by
relaxing
E
accommodation to
maintain clear
vision.

E E
E
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How lenses and prisms How lenses and prisms affect

affect eye alignment eye alignment
and focus: and focus:
Plus and Minus lenses cause defocus – the first eye
response will be to clear the image. The second
response is reflexive, the vergence will change. Lastly
the eyes will have to realign.
E E
Base-in and Base-out prisms cause disparity – the first eye
response will be to fuse the image. The second response is
E E reflexive, the focus will change. Lastly the eyes will have to
refocus.
THE NEAR TRIAD 37 THE NEAR TRIAD 38

How does the visual system Option #1 – it does NOT respond.

respond to a Base-out Prism? The image is blurry and double.

E E E E

EE EE
THE NEAR TRIAD 39 THE NEAR TRIAD 40

Base-Out Prism stimulate convergence. Through the CA/C, the eyes Step 1: Base-out
reflexively accommodate. This creates the situation where our eyes
must adjust by relaxing focus to keep the image clear and single.
E Prism stimulates
convergence to keep
the target single.

E E E E

EE EE
THE NEAR TRIAD 41 THE NEAR TRIAD 42

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Step 2: Convergence
stimulates Step 3: The eyes must relax focus to clear the
accommodation, E image. E
which makes the
target look blurry.

E E E E

E E
THE NEAR TRIAD 43 THE NEAR TRIAD 44

When the eyes

Step 1: Base-in Prism divergence to
E requires divergence to match the new E
keep the target single. image position, the
target becomes
single.

E E E E

EE EE
THE NEAR TRIAD 45 THE NEAR TRIAD 46

Step 2: Divergence
creates a relaxation
of accommodation, Step 3: The eyes
E E accommodate to make
which makes the
target look blurry. the image clear.

E E E E

E E
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1. Relax focus to clear the 1. Increase focus to clear

image. the image.
2. Eyes reflexively 2. Eyes reflexively
diverge. converge.
3. Converge eyes to 3. Diverge eyes to regain
regain single vision. single vision.

THE NEAR TRIAD 49 THE NEAR TRIAD 50

1. Diverge to fuse the 1. Converge to fuse the

image. image. 5
BO
2. Eyes reflexively relax 2. Eyes reflexively focus.
focus. 3. Relax
3. Accommodate to accommodation to
5
regain clear vision. BI
regain clear vision.

THE NEAR TRIAD 51 THE NEAR TRIAD 52