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  • Exophoria/Accommodation Spasm/Astigmatism - What should I do?

AGI

AGI It looks like your condition has degenerated very quickly if you were sort of symptoms-free one and half year ago.

It's not exactly like that. Considering my exophoria diagnosis is right I was never really 100% symptoms-free. I was always a slow reader and was getting very tired easily after reading or working up-close with computer screen. Back then I didn't blame my eyes at all. I thought it was normal or it was just an anxiety. I used to get a slight blurry vision after looking at my "good" screen, but as it was just a slight deterioration of my vision it was bearable, so I didn't complain. Now I know it was probably all my heterophoria.
I just think my brand new laptop screen was too demanding for my eyes with BVD and my heterophoria exploded with its worst symptoms I had never had before.

AGI I read online and I was told by one optometrist and one orthoptic that there is a sort of breakpoint, past which rest is the only solution and recovery can really take months without doing any close-up work. It is similar to a nervous breakdown.

One of orthoptists I saw told me I had a nervous breakdown and it manifested with my eyes. It didn't make sense as I was not very anxious in the time before I bought a new laptop. It was an easy diagnosis because she couldn't prove it and her treatment plan was financially and functionally demanding for me.
I was thinking of quitting any up-close tasks for months, but let's be honest, it's almost impossible. Maximum time I did was two weeks and all the symptoms came back immediately with the very first look at my phone. Sorry, but I don't think it's the way.

AGI I have no idea what the degree of your heterophoria is and I am not a trained specialist.

14 pd at near, measured a month ago. As others said, mostly there is no correlation between amount of your deviation and symptoms, but the last eye specialist told me that anything above 10 may be symptomatic. I found people having less than 10 and being extremely symptomatic.
Here are normative values from a good source and near lateral phoria is 3 XP +/-3.

AGI Sorry for being very direct, but after what you experienced (multiple pair of glasses, vision therapy) where do you get the confidence that a surgery will solve your issue? Also, at least in my case I do not think that esophoria is the principal culprit. That is what my orthoptists believe too.

I really believe people here suffer from different conditions which cause different symptoms, so your esophoria may indeed not be the culprit. After two years of wandering around all types of conventional and unconventional specialists I learnt one thing, always listen to your body and try to logically connect your main symptoms with conditions/diseases. I made many mistakes like letting having my neck muscles "corrected" (due to specialists it was the cause) and it resulted in constant neck pain I feel everyday ever since.
I just can feel my tired eye muscles everytime I finish looking at near screen and that's already a lot telling me what's the source of my symptoms. There is no magic.
I don't build up my opinion only on online posts, but I found many guys on reddit suffering from heterophoria and having the same symptoms.
Example 1
Example 2
Example 3 - this guy even did a surgery and 70% of his symptoms disappeared

The difference between them and us (probably most of us or at least some part) is that our condition became symptomatic with a new device, so it looks more like a magic than some health issues and that's why it's so hard and time-consuming to be properly diagnosed.

Anyway, I cannot be 100% certain if a surgery will help me, but it looks like it's the last resort for me. The last ophtalmologist (and surgeon) told me "You got the most of your VT, you tried different prisms, there's only a surgery left". I also asked her about anxiety as possible reason for me problems and she admitted it makes it worse, but the source is somewhere else.

AGI Please stay away from surgeons and medicines unless at least 50 doctors tell you it is the only way out :-)

Sure, I still have a few appointments booked to get more opinions.

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                Dominic 14 pd at near

                How was it measured? Did you notice any change from week to week? In my case, a week later the value had halved. I wonder how a doctor can prescribe glasses in this situation…I am sure you know where I am heading.

                Dominic I just can feel my tired eye muscles everytime I finish looking at near screen

                Is it totally unbearable? I am thinking in terms of the surgery. Clearly your decision, but I would go for the last resort only if I could not read anything at all. At times I feel like crying and recently I have become less productive, but I am hanging in there. Sometimes I also notice improvements that I cannot explain, as I cannot explain why all of a sudden a usable device hurts.

                Dominic You got the most of your VT

                I have seen three VT specialists so far and I just realized that my condition is a puzzle (maybe I should call it a mess). The specialists give me some directions but it is up to me to put the pieces together. I am still trying to clarify if there was a real change of my condition from exophoria to esophoria - currently it seems so, and the reasoning might be excessive exercising.

                Sometimes I need to reject input from the specialist that makes little sense. For instance, very recently I have been wondering why I am still given a lot of exercises that are typically prescribed for exophoria when I am affected by convergence excess. I believe that the specialists think that my problem with electronic devices is that I can converge but I cannot hold the convergence. I can do those exercises very easily, though. In fact I am always able to do the next-next level exercises with respect to what they prescribe. But now I clearly have pain afterwards. So these days I have been using the same stereograms but I am focusing on a point meters away instead of in-between the sheet and my nose. That is way more challenging. My "next-level stereograms" (I have made some myself) contain tiny letters, and reading the letters neatly while diverging looked impossible at the start. 1-2 days later I have already made good progress - I start believing that the goal is reachable. I am also doing more loose prisms exercises with the base in instead of out. This relaxes my eyes and diminish my symptoms. I just discovered it a few days ago after "studying" my primastic lenses and consulting with @Lauda89.

                Maybe I am just trying to be over-positive, but I like the feeling of hope, that I can work hard at something that I have not yet explored, and "dream" of improving my condition. I bought four pairs of glasses in the last 3 years and I never used them for longer than 2-3 days. A complete disaster. Besides, I watched this video. The specialist compares prisms to crutches. If you can, you should try to walk without or you won't get better.

                I have been long-winded, but perhaps you are willing to reconsider your statement that you already got most out of your VT. Cheers.

                        AGI

                        AGI @Dominic Have you (or anyone else) tried Syntonic Phototherapy?

                        I have not, but I can't find it anywhere in my country, at least not for eye purpose.

                        AGI Dominic 14 pd at near

                        How was it measured? Did you notice any change from week to week? In my case, a week later the value had halved. I wonder how a doctor can prescribe glasses in this situation…I am sure you know where I am heading.

                        Measured by cover test. Honestly I didn't write down my previous measurements and it doesn't look like my optimetrists liked this idea either as I cannot find it anywhere on the papers I have gathered. Next week I'm having the next appointment, so we will see if 14 pd is up to date.
                        However, I think there is a way to properly measure your deviation. My latest ophtalmologist told me to patch my left eye (as it's more symptomatic one) from the very first moment when I wake up and keep it untill I come for the appointment. Then I took off the patch right before the cover test. I think it makes sense as your covered eye squints to its maximum. Other than that way of doing a cover test may differ from each other because your eyes can be simply more or less tired. I think that's why I sometimes had a succes with devices at the first moment, but exactly the same device would had induced the symptoms an few hours later.

                        AGI I have seen three VT specialists so far and I just realized that my condition is a puzzle (maybe I should call it a mess). The specialists give me some directions but it is up to me to put the pieces together. I am still trying to clarify if there was a real change of my condition from exophoria to esophoria - currently it seems so, and the reasoning might be excessive exercising.

                        So you were diagnosed with exo before?
                        That's puzzling to me as well because I am always diagnosed with exophoria, but after months of excessive exercising when I wear my glasses the strain I feel is located between my eyes, not on the sides, what could indicate more of esophoria. To make it more complicated, base out prisms help me more than base in prisms. It should be the other way round for someone having an exophoria.
                        I'm still in doubt if it's certainly an exophoria or eso or some kind of vertical heterophoria (Maddox test shows a little bit of it), but I'm telling myself I saw some many eye specialists and literally all of them diagnosed me with exo deviation not even saying a word about other types of strabismus.

                        AGI For instance, very recently I have been wondering why I am still given a lot of exercises that are typically prescribed for exophoria when I am affected by convergence excess. I believe that the specialists think that my problem with electronic devices is that I can converge but I cannot hold the convergence. I can do those exercises very easily, though. In fact I am always able to do the next-next level exercises with respect to what they prescribe. But now I clearly have pain afterwards.

                        I have figured out something new to me recently. Most of those eye exercises strenghten eye muscles (medial rectus or lateral rectus muscles), but what if the trouble is that your muscles are too strong/tight? I think especially if your medial rectus muscles are too tight (then you are probably esophoric) you make it worse by doing convergence execises. If they are all right, but your lateral muscles are too strong then doing convergence exercises won't really help you to loosen your lateral rectus. Obviously there are still divergence exercises, but again they are made to strenghten your muscles, just the other way round than convergence exercises.
                        What I mean is that there is not many effective eye exercises loosening your muscles. This would explain why VT made my condition worse. It gave me a good convergence/fusion, but no essential change in my exophoria.

                        AGI I am also doing more loose prisms exercises with the base in instead of out. This relaxes my eyes and diminish my symptoms. I just discovered it a few days ago after "studying" my primastic lenses and consulting with @Lauda89.

                        This is very interesting. Given you have esophoria, most specialists would prescribe you base out prisms. I have the same problem, but in the other direction, with exophoria. Did you think up any possible explanation?

                        AGI I bought four pairs of glasses in the last 3 years and I never used them for longer than 2-3 days. A complete disaster. Besides, I watched this video. The specialist compares prisms to crutches. If you can, you should try to walk without or you won't get better.

                        I bought 20 pairs in the last 2 years, luckily they were not that expensive where I live. Dependency on prisms is something I fear of. I read stories people couldn't take a shower or wake up and open their eyes up even for a second withour wearing their prisms. Besides, I had my LASIK done 8 years ago thus I'm not happy with being glued to any kind of lenses.

                        AGI I have been long-winded, but perhaps you are willing to reconsider your statement that you already got most out of your VT. Cheers.

                        There's a long waiting line to have a surgery, so I still have months to try other things. For now, I do "exercises" by playing 3D games with cheap VR headset. After two days I'm sure it's not indifferent for my eyes because I feel their muscles right after a VR session.

                        By the way, I did VEP test this morning and they didn't find anthing alarming.

                                          Dominic Given you have esophoria, most specialists would prescribe you base out prisms.

                                          For esophoria at near only, plus lenses are usually preferred to try first, to relax convergence by manipulating the AC/A ration (e.g. the plus will relax accommodation, hence also relaxing convergence). If you have no need for glasses/contact lenses otherwise, a simple pair of reading glasses may do.

                                          • AGI replied to this.

                                              Dominic we will see if 14 pd is up to date.

                                              I was measured 14 diopters using a Howell card.

                                              A week after the value had halved. I am not sure what value my prismatic glasses were made on. I only know that after three days I had pain everywhere, neck, wrists, arms and even down to the ankles.

                                              Yesterday my orthoptist measured my esophoria to be 1^. She uses a different method, though. She has a vertical array of prisms of different power, one array for convergence and one for divergence. I look at a sheet with some letters behind the array, while she moves the array to increase the prism power until I start seeing double and I do not succeed merging the two letters. She takes note of the prism power. That reveals the extent of my heterophoria. If I understand, the Howell card measures the maximum heterophoria, which is not representative of one's eye condition at all times. Therefore, I wonder if my glasses were too strong because of the way my heterophoria was assessed. In any case, my orthoptist confirmed that there are different categories of people when it comes to prisms. Some "swallow" prisms and need to increase the power very quickly (she has seen a person who was desperate as her heterophoria had degenerated to 70^! The patient was unable to do anything without glasses). Other people cannot handle prisms at all independently of the power (like me?).

                                              Dominic Most of those eye exercises strenghten eye muscles (medial rectus or lateral rectus muscles), but what if the trouble is that your muscles are too strong/tight?

                                              That makes a lot of sense to me. One of the things I have been trying in parallel is to improve my posture. In this process I recently found out that I should not train my pectoral muscles as they are already super-tight. I should only stretch them and instead work out their antagonist muscles. I have no clue how to "stretch" eye muscles, though. I definitely noticed that if I keep doing convergence exercises, the area in between my eyes becomes very fatigued and I also develop a bit of headache. Yesterday my orthoptist asked me to do 80% of the training in "divergence mode" from now onwards. Those exercises are definitely more challenging. Afterwards I do not have pain / soreness, although my eyes quickly get tired when I look at objects 1-2 meters away through a base-in loose prism.

                                              Dominic Given you have esophoria, most specialists would prescribe you base out prisms. I have the same problem, but in the other direction, with exophoria. Did you think up any possible explanation?

                                              I am still elaborating on that!

                                                      ryans For esophoria at near only, plus lenses are usually preferred to try first, to relax convergence by manipulating the AC/A ration

                                                      I tried this solution too last week. With the glasses on, the reading of the Howell card jumps from yellow (7^-14^) to blue (4^). Sadly, no benefit. In fact I see slightly worse, although at least I do not have pain as with prisms.

                                                      I consulted my orthoptist, who was not surprised of the poor results. According to her, there is no such thing like everyone should have eyes aligned an exact way. I wonder if landing "mid-way" (reducing my heterophoria without jumping from eso to "light"-exo) is worth a go, but I am a bit nervous at my new trend of buying a pair of glasses every week.

                                                        AGI

                                                        AGI Yesterday my orthoptist measured my esophoria to be 1^. She uses a different method, though.

                                                        I'm not sure if I was ever measured by this method, but your result of 1^ seems to be minor.
                                                        The topic of fluctuations in results of heterophoria is very interesting. Every time when I do the Maddox Rod test, the red line is relatively close at first, but the longer I look the further it gets what means it's not very stable, but it also proves that eye muscles may constantly struggle to maintain the fusion/single image and they does sometimes better, sometimes worse. However, I think the maximum results is the most relevant, because even if your eye muscles do better sometimes, they still need to put some effort and the more effort they put, the more tired they are at the end. Looks like I'm also one of those who cannot handle prisms.

                                                        AGI Yesterday my orthoptist asked me to do 80% of the training in "divergence mode" from now onwards. Those exercises are definitely more challenging. Afterwards I do not have pain / soreness, although my eyes quickly get tired when I look at objects 1-2 meters away through a base-in loose prism.

                                                        I also find divergence exercises way more challenging than those improving convergence, but my orthoptists never really care about it.

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                                                              13 days later

                                                              Have you tried "accomodative" contact lenses? I wear Biofinity Energys all day every day (+5.5 and +1.5), with glasses over top that correct for astigmatisms only.

                                                              I get weird feelings of warmth from my vision being off, along with slight headaches, dizziness, nausea… that could just be stress related. Bodies react to stress in countless ways.

                                                                pejalo
                                                                Yes, I tried plus power lenses, they actually make my symptoms worse.
                                                                Though it's an excellent question because now I perfectly know why and I would like to share it with you here. When it's heterophoria that is the culprit of symptoms, your eyes try to "mask" your binocular vision issues by your accommodation. That's why many of us complain of blurred vision among arising symptoms.
                                                                It's a huge discovery to me that if you do the cover test (one of the principal heterophoria measurement method) with your accommodation excluded your result may be completely different from one when your accommodation is "turned on". I mentioned in this thread that my exophoria was 14, but it's actually 21-25 when my accommodation is loosened.
                                                                How to loose your accommodation? It can be simply done by wearing +3D lenses.

                                                                By the way, this also provides the final answer for the title question I asked almost a year ago. It's not a spasm of accommodation itself. It's my exophoria that brings the spasm of acc.

                                                                pejalo I get weird feelings of warmth from my vision being off

                                                                I'm surprised, but kind of glad to read this because I also have these feelings of warmth. Now I'm 100% sure they come from my vision, but everyone was telling me it was stress related. Could you describe these feelings a bit more? Where are they located, what parts of your body? By the way, did you test your binocular vision?

                                                                • AGI replied to this.

                                                                      pejalo "accomodative" contact lenses

                                                                      Dominic Yes, I tried plus power lenses

                                                                      Can you guys please elaborate on this? Sorry, I don't know much about glasses. Is this correction what's typically prescribed for presbyopia, namely, +0.5, +1 etc reading glasses? Thanks.

                                                                          3 months later

                                                                          @Dominic How are you? It's been 2 months since your last message. Anything changed? Your condition is somewhat similar to mine. For 4 months I have had persistent accommodative spasm and convergence insufficiency. It was a sudden onset. My symptoms are stabbing eye pain when looking at screens and feeling like image is "out of sync" (that is 24/7), there is some misalignment but difficult to describe. There is no double vision but something is off. No headaches though. It turned out I had sinusitis and had to do a surgery, but that didn't resolve vision problems. I will start vision therapy soon. So far at home exercises and wearing correction of plus lenses (+0,75 on both eyes) didnt give me any results.

                                                                          Few questions: Did you measure your exophoria at near/far at the begnning over a year ago and now? Do you know if it has changed? For how long have you tried plus lenses? From what I've read they say that there sometimes might be an adjustment period where the eyes might hurt a bit. And I assume despite the pain you still use screens from time to time (like me) because nowadays you literally cannot do anything without them. On average how much time daily do you still spend looking at them?

                                                                          Also, you might be interseted in the book I recently found: "Clinical Management of Binocular Vision". Very in depth about the things you write about. There is 4th version downloadable on the internet. There is also 5th ver in online stores, although i's pretty expensive.

                                                                          dev