Natural strabismus in monkeys: accommodative errors assessed by photorefraction and their relationship to convergence errors.

PURPOSE To examine accommodation and accommodative convergence relationships in naturally strabismic monkeys. METHODS Photorefraction was used to measure accommodative responses of each eye under monocular and binocular viewing conditions. These accommodative results were then compared to assessments of vergence state made under monocular viewing conditions using methods previously described. RESULTS Accommodation was always accurate under monocular viewing conditions, with the exception of the inability of one myopic eye to focus distant targets. The accommodative response in the two eyes was always consensual. In animals with an anisometropia, the fixating eye was focused accurately on the target, and the fellow eye was in error by an amount predicted by the magnitude of the anisometropia. Some animals alternated fixation, and, under these conditions, control of accommodation and fixation switched in tandem. Accommodative convergence ratios (AC:A) were abnormally low in animals with strabismus syndromes, similar to human essential infantile esotropia, and were excessively high in animals with syndromes, similar to human early onset accommodative esotropia. CONCLUSIONS There was no evidence that the strabismus seen in any of the monkeys was related to errors in accommodation. However, the crosslink gain between accommodation and vergence was abnormal in some of the animals. These abnormalities have the effect of driving vergence toward a misalignment that can only be overcome by other factors, such as fusional vergence. Thus, the authors speculate that these abnormalities in synkinesis between accommodation and convergence were present during early postnatal development when fusional vergence is weak, and that they acted as predisposing factors for the development of strabismus.