Psychological approach to treatment of accommodative / convergence anomalies
Reviewed by Fiona Rowe

A case series is presented of affected children, young people and young adults with discussion of a psychological approach to aiding their accommodative problems. The psychological approach involved an information sheet provided at the end of assessment which included explanations of the impact of stress / anxiety on physical symptoms. A cognitive behavioural approach was adopted to explain and reassure patients. Signposting to other appropriate organisations was undertaken. An explanation was given on ‘downward spiral’ and ‘psychological upslope’. The case series included 23 patients aged 8-30 years. Tertiary referrals accounted for 70%. The most severe cases had accommodative paralysis or spasm. All patients had inconsistent responses with poor linear relationships between accommodation and convergence. Thirteen had accommodative weakness and 10 had accommodative spasm. These patients were not classified as functional loss of vision as they had a genuine anomaly, although with a mainly psychological origin. This psychological approach changes the treatment emphasis to a holistic approach. Treatment combines simple eye approaches such as glasses and exercises, reassurance and giving the patient insight, encouraging a move away from checking their problem and signposting to other appropriate support. There is potential to break a vicious cycle in this way.

Using evidence-based psychological approaches to accommodative anomalies.
Horwood AM, Waite P.
STRABISMUS
2023;31(1):45-54.