of patient answers. Furthermore, the whole procedure placed less emphasis on verbal communication skills of our young uncooperative patients. Finally, the precise and automatic manner in which preprogrammed changes in convergence demand took place was most likely a primary factor
generating large increases in convergence ranges. It is unlikely that such gradual and small incremental and decremental changes in convergence demand could have been accomplished during the course of standard vectogram training. Further controlled studies are planned in order to evaluate the relative contribution of each of the factors contained in the present procedure.
The second experiment demonstrated that improvement in convergence ranges was due to programmed increases in convergence demand rather than exposure to stereograms containing no convergence demand. Experimental subjects receiving RDS convergence training demonstrated increased convergence ranges, whereas control subjects did not. This finding, although not unexpected, supports the notion that strict attention should be paid to the manner in which changes in convergence demand are programmed in convergence training.
The findings from experiment 1 not only demonstrated a relatively direct transfer of convergence skills acquired during RDS training to standard vectograms, but also indicated that such training can affect more general binocular dysfunctions. For example, one of our young patients, originally exhibiting an intermittent exotropia prior to training, was found to have an exophoria following training. Thus, the operant RDS convergence training procedure might be helpful in reducing the amount of deviation in intermittent strabismics.
In summary, although the present operant RDS convergence training technique was performed with fairly sophisticated equipment, we feel that the general characteristics of the procedure might easily be translated into an effective and efficient clinical tool. The training of convergence skills, especially with young, poorly motivated, inattentive, and communicatively inexperienced patients, should always involve a procedure demanded by these patient