Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Normal heterophoric changes: 20 years' follow-up

  • 94 Accesses

  • 14 Citations


• Background: Evaluation of changes in the heterophoric condition of 100 normal individuals over a 20-year period. • Methods: A reprospective study was undertaken. Charts of 100 normal men were reviewed. Individual changes in the heterophoric status were recorded over a 20-year period. The average value of the phoria at age 18–22 years was compared with the average value at age 34–38 years. Measurements were taken for near and distance fixation. No one was heterotropic. Changes in convergence and accommodation were also calculated. • Results: A 0.9 ± 1.7 prism diopter increase in esophoria for distance fixation and a 0.6±2.5 prism diopter increase in exophoria for near fixation were found. These changes were statistically significant (P<0.001 andP<0.02 respectively). The near point of convergence receded by 0.5 ± 1.1 cm (P<0.001), and a decrease in accommodation over time of 2.8 ± 1.4 diopters was found (P<0.001). • Conclusion: An increase in esophoria for distance fixation and a exophoria for near fixation was found in a 20-year follow-up of 100 normal subjects.

This is a preview of subscription content, log in to check access.


  1. 1.

    Alpern M (1950) The zone of clear single vision at the upper levels of accommodation and convergence. Am J Optom 27: 491–513

  2. 2.

    Breinin GM, Chin NB (1973) Accommodation convergence and aging. Doc Ophthalmol 34: 109–121

  3. 3.

    Duane A (1922) Monocular and binocular accommodation. Am J Ophthalmol 865–877

  4. 4.

    Duane A (1925) Subnormal accommodation. Arch Ophthalmol 54: 566–587

  5. 5.

    Eames TH (1933) Physiologic exophoria in relation to age. Arch Ophthalmol 9: 104–105

  6. 6.

    Fincham EF (1957) The proportion of ciliary muscular force required for accommodation. J Physiol (Lond) 135: 488–508

  7. 7.

    Freier BE, Pickwell LD (1983) Physiological exophoria. Ophthalmic Physiol Opt 3: 267–272

  8. 8.

    Miller JE (1975) Aging changes in extraocular muscle. In: Lennerstrand G, Bach-y-Rita P (eds) Basic mechanisms of ocular motility and their chemical implications. Pergamon, Oxford, pp 47–61

  9. 9.

    Morgan MH, Peters HB (1951) Accommodative convergence in presbyopia. Am J Optom 28: 3–10

  10. 10.

    Moses RA (ed) (1972) Adler's physiology of the eye. Mosby, St. Lopuis, p 317

  11. 11.

    Noorden GK von (1990) Binocular vision and ocular motility, 4th edn. Mosby, St Louis, p 86

  12. 12.

    Sheedy JE, Saladin JJ (1975) Exophoria at near in presbyopia. Am J Optom Physiol Optics 52: 474–481

  13. 13.

    Tasman W, Jaeger EA (eds) (1986) Duane's clinical ophthalmology, vol 1. Lippincott, Philadelphia, Chap 33, pp 51–52

Download references

Author information

Correspondence to Abraham Spierer.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Spierer, A., Hefetz, L. Normal heterophoric changes: 20 years' follow-up. Graefe's Arch Clin Exp Ophthalmol 235, 345–348 (1997). https://doi.org/10.1007/BF00937281

Download citation


  • Public Health
  • Normal Individual
  • Distance Fixation
  • Individual Change
  • Prism Diopter