Study of the dynamic interactions between vergence and accommodation

Abstract

<em>Introduction:</em> Accommodation (change in ocular focus) and Vergence (change in ocular alignment) are two ocular motor systems that interact with each other to provide clear single binocular vision. While retinal blur drives accommodation as a reflex, retinal disparity changes accommodative position through the convergence-accommodation (or simply vergence-accommodation, VA) cross-link. Similarly, while retinal disparity primarily drives the vergence system, a change in retinal blur alters vergence through the accommodative-convergence (AC) cross-link. Although much information is known on the individual response dynamics of blur accommodation and disparity vergence, very little is known about the cross-linkages AC and VA. VA represents the unique situation where a stimulus to vergence (retinal disparity) drives a change in accommodation. When these dynamic measures are compared to those of vergence and blur accommodation a better understanding of the critical or rate limiting step within the system of vergence and accommodation can be determined. Accordingly, the purpose of this thesis was to determine the response dynamics of vergence driven accommodation (VA) and compare the response parameters to simultaneous measures of disparity vergence and blur driven accommodation. <br /><br /> <em>Methods:</em> A disparity stimulus generator (DSG) was modified to allow step stimulus demands of disparity to be created on a 0. 2 cpd non-accommodative difference of Gaussian target. Retinal disparity of different step amplitude demands were created as an ON / OFF paradigm and projected on a stereo monitor set at a distance of 1. 2m. Two experiments were conducted. The first experiment investigated the first order properties of VA in comparison to similar measures of blur driven accommodation (BA). The second study aimed at comparing the first order and second order dynamics of disparity vergence, VA and BA. <br /><br /> In the first experiment, stimulus measures of vergence, vergence-accommodation and BA were studied. Six normal young adult subjects participated in the study. Accommodation was measured continuously at 25Hz with the commercially available PowerRefractor (Multichannel systems, Germany). A Badal optical system was designed and accommodative response to step stimulus demands were measured. VA and BA measures obtained from the PowerRefractor were matched and plotted as main sequences (amplitude vs. peak velocity). Peak velocities between the two responses were compared using two-way analysis of variance (ANOVA) with Bonferroni post-tests. <br /><br /> In the second experiment, the response dynamics of vergence, vergence-accommodation, and blur accommodation were assessed and compared on 6 young adult subjects. Eye position was measured continuously by a stereo eye tracker at a sampling rate of 120Hz. A high speed photorefractor (sampling = 60Hz) was custom designed and synchronized with a stereo eye tracker to allow simultaneous measurement of vergence and VA. Monocular blur driven accommodation measures were also obtained with the Badal optometer and the high speed photorefractor (sampling = 75Hz). VA, BA and disparity vergence responses were analyzed and temporal parameters like latency, amplitude, duration, time to peak velocity, peak acceleration, duration of acceleration, and skewness were calculated. Main sequence plots (response amplitude vs. peak velocity) were generated and compared between disparity ON and disparity OFF. The dynamic measures of VA were compared to the measures of monocular blur driven accommodation. All comparisons were done using a two-way ANOVA with Bonferroni post-tests. <br /><br /> <em>Results:</em> <br /> <em>Study 1:</em> The results showed that response amplitude of VA during disparity ON and disparity OFF paradigms was linearly related to the peak velocity for an amplitude range of 0. 5 to 2. 5 D (Disparity ON: peak velocity of vergence-accommodation = 0. 812 * amplitude + 1. 564, R² = 0. 452, p<0. 0001 and Disparity OFF: peak velocity of vergence-accommodation = 1. 699* amplitude ? 0. 234, R² = 0. 86, p <0. 0001). The rate of change of peak velocity as a function of response magnitude was lower for VA during disparity ON compared to VA during disparity OFF. BA responses also showed amplitude dependent dynamic properties (Accommodation peak velocity = 1. 593 * amplitude - 0. 008, R² = 0. 84, p<0. 001; Dis-accommodation peak velocity = 1. 646 * amplitude - 0. 036, R² = 0. 77, p<0. 001). There was no statistical difference in the velocity of accommodation and dis-accommodation. <br /><br /> <em>Study 2:</em> When amplitudes were matched, disparity vergence response during disparity ON and disparity OFF had similar main sequence relationships. The mean values for the stimulus and response VA/V ratios were similar (0. 13±0. 05 D/&Delta; and 0. 15±0. 09 D/&Delta; respectively). All the temporal parameters of vergence-accommodation were similar during disparity ON and disparity OFF paradigms. When blur accommodation and vergence-accommodation measures were compared, all the first order and second order temporal parameters in the response were similar between the two systems. Also, disparity vergence exhibited significantly greater peak velocity and peak acceleration compared to two accommodation responses. The results also confirmed that the velocity of accommodation and dis-accommodation showed a statistically significant linear relationship as a function of amplitude for the range of amplitudes tested (Accommodation, y = 2. 55x + 0. 65, R² = 0. 55, p<0. 0001; Dis-accommodation, y = 2. 66x + 0. 50, R²=0. 65, p<0. 0001). <br /><br /> <em>Conclusions:</em> The dynamic properties of VA are amplitude dependent. Although initial results from study 1 suggested that VA may be slower during disparity ON, the results from study 2 using the high speed photorefractor and an improved analysis procedure showed that VA responses were equally fast between disparity ON (convergence) and disparity OFF (divergence). All temporal properties of VA were independent of vergence type (convergence/divergence). VA and BA have similar dynamic properties in humans suggesting that they may controlled by a common neural pathway or limited by the plant. Also, when compared to accommodation responses, disparity vergence exhibited greater velocities and accelerations reflecting the differences in the magnitude of neural innervation and plant mechanics between the two systems. The study also confirmed amplitude dependent response dynamics of blur driven accommodation and dis-accommodation.