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Sheard's criterion describes whether a phoria is likely to become decompensated (symptomatic) in reference to the opposing fusional reserves, which should be at least twice the value of the phoria.
Accommodative insufficiency (AI) is a non-strabismic binocular vision anomaly that is characterized by an inability to focus or sustain focus for near vision. 1. AI is a sensory-motor anomaly, clinically manifesting as a reduced amplitude of accommodation compared to age-matched norms.
The fusional reserve that opposes the heterophoria is measured first (convergent, using base-out prisms, for exophoria), to blur point (if present), break point, and then the prism is reduced until the recovery of single vision.
Fusional reserves are a measure of how much vergence a person has in reserve that can be used to overcome a heterophoria. The patient is instructed to fixate on a near target (usually at 33 cm) binocularly and a horizontal prism bar is placed before one eye starting with the weakest prism strength.
Typically, there are a few different causes of accommodative insufficiency. Children who have had poor health overall and suffered from illnesses such as a severe flu bug, glandular fever, or chronic fatigue can develop weak focus. It can also be a side effect of some medications or visual stress.

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The fusional reserves are the maximum amount the eyes can converge (positive fusional reserves, measured with base out prism) or diverge (negative fusional reserves, measured with base in prism) while still maintaining BSV. As the image doubles, the break point is reached.
Normal Fusional Vergences DirectionFusional Vergence Range (prism dioptres)Vertical2-3Torsional2-3Convergence15-20 distance; 25 nearDivergence6-10 distance; 12 near
Positive vertical vergence is a simultaneous elevation of the right eye and depression of the left eye, compensating for a left hyperdeviation by maintaining a left hyperphoria.
Negative fusional vergence ability (i.e., divergence amplitude) at near, however, is often assumed to be normal or of little consequence for patients with convergence insufficiency; thus, little attention has been given to this clinical measure.
(NFV-negative fusional vergence; PFV-positive fusional vergence; NPC-near point of convergence; RE-right eye) From: Convergence insufficiency and accommodative insufficiency in children. Condition.

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