This protocol is for patients with convergence insufficiency presenting as intermittent exotropia at near fixation — specifically when a completed course of orthoptic therapy or convergence exercises has failed to achieve adequate fusional control or relief of near-work symptoms.
The typical patient — often an older child or teenager — has intermittent exotropia at near fixation, reduced fusional convergence amplitudes, and a remote near point of convergence. Asthenopic symptoms with near work are a prominent complaint.
Orthoptic therapy and convergence exercises — including near point of convergence exercises on an accommodative target, convergence training with a base-out prism once the near point improved, computer-based convergence programmes, or in-office orthoptics — were used to improve fusional control and resolve asthenopic symptoms with near work. This protocol is indicated when those goals were not achieved.
Improved comfort while reading and relief of asthenopic symptoms associated with near work.
In this refractory setting, management shifts to an optical aid incorporated into the patient's eyeglasses, targeting symptom relief during near tasks. The complete specification — and the evidence context around its effectiveness — is in the full protocol.
DOI: 10.1016/j.ophtha.2022.11.002