A) Definition of Fusional Reserves

FUSIONAL RESERVES
a) Definition of fusional reserves

b) Measurement of fusional reserves
c) Normal values
d) Interpretation
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Learning objectives
• By the end of this session , you will be able to:
Define fusional reserves and related terms
Interpret the measurement of fusional reserves
Demonstrate how to measure and record results
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Important Terms
 Fusion
 Sensory Fusion
 Motor Fusion
 Central Fusion
 Peripheral fusion
 Fusional Movements
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Definition of terms
Fusion - defined as the unification of visual
excitations from the corresponding retinal images
into a single visual percept
Sensory Fusion
- Neural process by which the images of in each
retina are integrated in to a single percept.
- In normal binocular vision, this occurs when
corresponding regions of the retina are stimulated.
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Motor Fusion
- One of the components of convergence in which the eyes
move until the object of regard falls corresponding retinal areas
Central Fusion
- Images are in central part of retina.
Peripheral Fusion
- Images are in peripheral part of retina.
Fusional Movements
– Reflex movements of the eyes in response to retinal disparity in order
to produce a single image.
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Definition of Fusional Reserve
Represents the amount of divergence or
convergence which can be induced before
fusion is compromised ( blurred or double vision
occurs.)
The fusional reserves are a measure of how much
vergence the person has ‘in reserve’, which can be
used to overcome their heterophoria
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Fusional R. cont’d
• A key factor determining a person’s ability to
compensate for a phoria is the Fusional reserve
that they use to overcome the heterophoria.
=> “THE OPPOSING FUSIONAL RESERVE”
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• In exophoria  Convergent Fusional reserve.
• Convergent fusional reserve (+ve) measured using
base out prisms.
• In esophoria  divergent fusional reserve (-ve)
measured using base in prisms.
• Vertical reserves measured using vertical prisms
(base up or base down).
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a) Measurement methods
Prism bar
• Px fixates at small letters enough to:
- require precise fixation

- stimulates accommodation
• The fusional reserve opposing heterophoria
should be measured first.
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• Introduce prism and then slowly increase prism power ~
rates of 1Δ per second.
• Px should report:
1.when the target goes blurred  blur point.
2. When the target goes double  break point.

3. Decrease prism power until single
vision is maintained  recovery point

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Fusional reserves assessment
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Measurement cont’d
• Record the result as : Blur/Break/Recovery
E.g. Fusional reserve:

.Distance convergence : 12/20/15
.Distance divergence : -/10/8
=> Measured at Distance and Near
Near convergnce:
Near divergence:
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1) Measuring +ve fusional vergence @ distance
- vertical row of 6/6 letters
- increase base out prism in front of each eye.
A) report if letters blur – blur point i.e. limit of
accommodation .
B) report double vision – break point -> limit of
convergence
C) decrease prism power until Px reports returns to
single vision -> recovery
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2) Measuring –ve fusional vergence @distance
- vertical row of 6/6 letters
- increase base in prism equally in front
of two eye.
• In distance vision there should be no blur point. Since
there is no negative accommodation (as long as Px RE is
fully corrected)
• If Px does report blur -> accommodation is being relaxed
to use accommodative divergence.
• Decrease base in prism until Px reports return to single
vision =recovery point . nebiyat
9/25/20 14
3. Measuring +ve and –ve fusional vergences at near
- Single vertical row letters at 40cm
• Measure vergences in same manner.
•However, at 40cm 2.50D
accommodation is stimulated.
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4) Measuring vertical vergence
o Single horizontal row of 6/6 letters at
6m/40cm
o Prism is introduced in front of one eye only
o Blur will not occur as vertical prism has no
effect on accommodation
o Increase vertical prism until diplopia ->break
pt
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• Decrease prism power single
Again ->recovery point
• Only necessary to measure if patient is found to
have a vertical phoria
Vertical vergences:
1. right supra-vergence = base down, right eye
2. right infra-vergence =base up, right eye
3. left supra-vergence =base down LE
4. left infra-vergence = base up, LE
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Record e.g.
R: S 3/1 L: S 4/2
I 4/2 I 3/1
RS should equal LI
RI should equal LS
• Results can be compared with norms but it more
meaning full to relate the results to the
heterophoria.
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B) Normal values
To blur To break Recovery
Distance(6m)
Base in vergence -ve - 8 4
Base out vergence +ve 4 20 12
Near (33-40cm)
Base in vergence -ve 15 8
Base out vergence +ve
8 30 20
Vertical both 4 2
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c) Interpretation of results
1. Percival’s middle third
• Percival’s criterion says that that, the fusional
reserves should be balanced so that the smaller
fusional reserve is more than half the larger one.
e.g. If convergent fusional reserve to break point

is 20Δ , then the divergent fusional reserve
should be at least 10Δ .
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 The working fixation point (zero) should be lie
in the middle third of the total fusional
amplitude(ZCSBV) i.e. addition of divergent
and convergent break points.
 Does not take account of the exo phoria.
 Useful for esophoria Px’s
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-ve FR = 12 +ve= 36
• 12_____________16_________________36
-ve FR zero +ve
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2). Sheard’s criterion
The fusional reserve (to blur or if no blur to break) that
opposes the heterophoria should be at least twice the
heterophoria.
e.g. If a patient has 8Δ Exop @ near then their convergent
fusional reserve (+ve, base out) should be at least 16Δ
- Works well for exophoria at distance.
- Only measure fusional reserves on Px who has
9/25/20
decompensated phoria.nebiyat 23
Correcting Prism for phoria
1)Percival
• prism diopters = (1/3)*PRC - (2/3)*NRC
2)Sheard
prism diopters = (2/3)*demand - 1/3)*reserve
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• Do not measure in “routine” examination because:
1. Often gives Px a headache
2. Results not repeatable ->improve with practice.
3. Results can be affected by the rate of change in prism
powers.
4. If measure –ve fusional reserve after +ve, result may
be affected by neural/muscular tonus.
• However, one very significant finding:
- divergent (-ve) reserve for distance is very small
- if result is very large ( over 9Δ to break) = divergence
9/25/20
excess. nebiyat 25
Summary
Fusion, whether sensory or motor, is always a
central process i.e. it takes place in the visual
cortex.
Fusion assessment is essential both for the
prognosis and management of strabismus
we have to compare the amount of measured FR
with normal values and the amount of
heterophoria
9/25/20 nebiyat 26

A) Definition of Fusional Reserves

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FUSIONAL RESERVES

a) Definition of fusional reserves

- require precise fixation

1.when the target goes blurred  blur point.

2. When the target goes double  break point.

vision is maintained  recovery point

E.g. Fusional reserve:

- Single vertical row letters at 40cm

• Measure vergences in same manner.

•However, at 40cm 2.50D

Base in vergence -ve - 8 4

Base out vergence +ve 4 20 12

e.g. If convergent fusional reserve to break point

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