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AMERICAN JOURNAL 0F OPTOMETRY & PHYsIoLoGIcAL Orrics

Copyright 0 1988 AMERICAN ACADEMY 0? OPTOMETRY

Vol. 65, No. 8, pp. 466-463

Print.d in U.S.A.

Symposium paper

Review of Computerized Orthoptics with

Specific Regard to Convergence Insufficiency

JEFFREY COOPER’

state College of Optometry, State university of New York, New York, New York

ABSTRACT

Traditional vision training or orthoptics has

used line or contour targets to eliminate

suppression and improve vergence perform-

ance. Manipulation of these stimuli is slow and

arduous. Une stimuli require an experienced

doctor/technician to Interpret responses. Re-

cently, automated vision training using micro-

processor anaglyph stimuli, i.e., random dot

stereograms (RDS), has been used in an op-

erant conditioning paradigm. This technique

has improved motivation of the patient, im-

proved reliability, and provided standardiza-

tion of therapy. In addition, the utilization of

RDS associated with operant conditioning has

been shown to improve vergence performance

and to reduce asthenopia in the convergence

insufficiency patient

Key Words: vision training, orthoptics, ver-

gence, fusion, random dot stereograms, op-

erant conditioning, asthenopla, convergence

insufficiency, binocular vision

Orthoptic and vision training have utilized

vectograms, stereoscopes, synoptoscopes, and

other types of devices to present visual stimuli

binocularly. Traditional methods of changing

stimulus parameters (e.g., vergence demand)

This paper is based on an oral presentation given

by Dr. Cooper on December 16, 1986 at the Sympo-

sium of Convergence Insufficiency. The meeting was

sponsored by the Binocular Vision and Perception

Section at the Annual Meeting of the American Acad-

emy of Optometry, Toronto, Ontario, Canada.

Received January 5, 1988.

Optometrist, Member of Faculty, F.A.A.O.

have been slow and unreliable. Thus, reproduc-

ibility in testing and training may be question-

able because doctors and technicians may alter

targets at different speeds and instruct or mo-

tivate patients differently. Moreover, traditional

vision training techniques require an experi-

enced doctor/technician to interpret patients’

responses and to use that information to alter

stimulus conditions in order to improve binoc-

ular response. These problems are observed in

the young or noncommunicative patient.

The difficulties noted above have led

some practitioners to abandon orthoptics/vision

training. They may also be responsible for var-

iability in reported success rates of orthoptics.

In a similar area, visual field testing, microproc-

essor-controlled response-stimuli presentation

has improved reliability, improved detection

rate, and in general brought scientific validity

into the area of in-office perimetry. Recently,

research-oriented automated microprocessor-

controlled methods have been reported in the

field of orthoptics/vision training.

Cooper and Feldma& demonstrated that RDS

presented in an operant conditioning paradigm

could be used to improve stereoscopic responses

in young children. In their study, young children

were tested with a Titmus stereo test, a Random

dot E test, and with a RDS test in an operant

conditioning paradigm. The RDS test used by

Cooper and Feldman required the patient to

wear Polaroid glasses while looking at a screen,

and to push a button which contained a visual

two-dimensional pattern that matched the one

projected on the screen. The RDS was projected

with a stereoscopic square one-hall of the time

or with a RDS that lacked disparity (flat fusion

stimulus) the other one-half of the time. Correct

responses were reinforced, whereas incorrect re-

sponses were not. If the child could not perceive

the stereo RDS, monocular (brightness con-

455