972 BENJAMIN Borishs Clinical Refraction

TABLE 22-4 Morgan's Expecteds

Test/Description Norms Range Group'

No.8: Phoria at distance (far) 16 exo±1 ortho to 26 exo C

No.9: Convergence-BO blur at far 96 ± 2, or no blur 76 to 11 6, or no blur B
No. 10: Convergence
BO break at far 196 ± 6 15 6 to 23 6 B
BO recovery at far 106 ± 2 86 to 126 B
No. 11: Divergence
BI t break at far 76 ± 2 56 to 96 A
BI recovery at far 46 ± 1 36 to 56 A
No.5: Dynamic retinoscopy* +1.37 D ± 0.12 1.25 D to 1.50 D B
No. 14A: Monocular cross-cylinder* +1.00 D ± 0.25 0.75 D to 1.25 D B
No. 14B: Binocular cross-cylinder* +0.50 D ± 0.25 0.25 D to 0.75 D B
No. 13B: Phoria at near 36 exo ± 3 ortho to 66 exo C
No. 16A: PRV-BO blur at near 176 ± 3, or no blur 146 to 206, or no blur B
No. 16B: PFR
BO break at near 21 6 ± 3 186 to 246 B
BO recovery at near 11 6 ± 4 76 to 156 B
No. 17A: NRV-Bl t blur at near 136 ± 2, or no blur 116 to 156, or no blur A
No. 17B: NFR
BI break at near 21 6 ± 2 196 to 23 6 A
BI recovery at near 136 ± 3 106 to 166 A
No. 20: PRA t -2.37 D ± 0.62 -1.75 D to -3.00 D A
No. 21: NRA* +2.00 D ± 0.25 +1.75 D to +2.25 D B
Stimulus ACjA ratio 46 ± 1 36 to 56 C
No. 19: Amplitude of accommodation Based on agel ±2.00 D A

Modified from Morgan MW. 1944. Analysis of clinical data. Arch Am Acad Optom 21:477.
BO, Base-out; BI, base-in; PRY, positive relative vergence; PFR, positive fusional reserve; NRY, negative relative vergence; NFR, negative fusional
reserve; PRA, positive relative accommodation; NRA, negative relative accommodation; AC/A, accommodative convergence/accommodation.
•While the far-point tests 9, 10, and 11 have been classified here, Morgan did not indicate these tests specifically in his groupings. The analysis was
apparently made on the basis of the nearpoint tests 16A and 16B and 17A and 17B alone.
'There is no Bl to blur at far.
IThe norms for tests 5, 14A, 14B, 19,20, and 21 are powers in addition to the subjective refraction. Today, we refer to Hofstetter's formulas (see
Chapters 10 and 21) to establish the norm and range for amplitude of accommodation. Note that the norm for dynamic retinoscopy is +0.50 to
+0.75 greater than expected (see text).

be discussed in the following patient scenarios will be
the graphical analysis model, with the patients' data
graphed for visual understanding of the accommoda-
tive-convergence relationships, and Morgan's normative
values. Any prismatic considerations and management
options will have Sheard's criterion and Percival's crite-
rion as their basis. Management options of the particu-
lar patient encounters will amplify the basic models
aforementioned to illustrate clinical judgment in light
of varying patient scenarios.
Morgan's normative values are illustrated in Table 22-
4. The nongraphical basis of these values is founded on
comparing the patient data to established data-collected
clinical normative values for analysis of problems. As
with graphical analysis, the normative values have to be
considered in the light of the patient symptomatology,
varying patient responses, and clinical judgment of the
practitioner. With the advancement of the current
knowledge base, clinical judgment must have the pre-
eminent place in making correct patient management
decisions.
PRIMARY MYOPIA
Myopia can result from a longer-than-normal axial
length (axial myopia) or from a steeper-than-normal
corneal curve (refractive myopia). A myriad of theories
deal with myopia's etiology. Whatever the cause, the
focus of parallel light before the retina and its effect on
vision is the same-blurred distance vision. This char-
acteristic reason for an uncompensated myopic patient