According to v. Graefe the diagnosis of this condition must be carried
out in the following way. First of all the convergence must be fixed on
a near object in the median line; if one eye remains behind in the
movement it may be accounted for in various ways, for example, the
impediment of movement caused by the change in form of the eye in myopia
or the faulty innervation of the interni mentioned on p. 54. In both
cases for the most part no dynamic, but manifest relative divergence is
present in viewing near objects. It may also happen that the patient
does not converge sufficiently, merely because accommodation is absent.
This experiment does not then prove the presence of dynamic relative
convergence, and v. Graefe came to the conclusion, therefore, that a
normal position of the eyes obtained only by the habit of binocular
single vision must be relinquished so soon as we cause binocular single
vision to cease. Just as under these circumstances dynamic absolute
divergence is manifested in the observance of distant objects, so must
this be the case in dynamic relative divergence in the observance of
near objects. One eye is first excluded while looking at an object about
25 cm. distant, to determine whether it still remains in a proper
position for fixation. We have reason to believe that the position which
occurs in the excluded eye answers to the given conditions of tension of
the muscles. Still it is not necessary to cause binocular vision quite
to cease, it is sufficient and even more advantageous, simply to make
binocular single vision impossible, which we are able to do by means of
prisms. If, for example, a point be fixed lying at the usual distance
for work of 25 to 30 cm., or, according to v. Graefe, a large spot
intersected by a vertical line, and one then applies a vertically
deviating prism to one eye, the influence of binocular single vision on
the ocular muscles is removed, as the fusion of the double images
standing above one another is impossible; and nothing prevents the
assumption of a relative position of divergence instead of a proper
convergent one; as a result of this the double images show a crossed
lateral position as well as the difference in height produced by the
prism. The extent of this lateral deviation may be measured by means of
prisms, which being applied to the eyes with the bases inwards place the
double images again perpendicularly above one another. Von Graefe holds
it to be of importance to determine the strongest prisms which can be
overcome for the given distance by means of convergence and by the
outward movement of the eyes.
Public-domain text, read in full here on John Shaqi.
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