Original Research

Heterophoria, fusional vergence, and near point of convergence in Sudanese hospital-based population

Saif H. Alrasheed, Sulaiman Aldakhil
African Vision and Eye Health | Vol 83, No 1 | a869 | DOI: https://doi.org/10.4102/aveh.v83i1.869 | © 2024 Saif H. Alrasheed, Sulaiman Aldakhil | This work is licensed under CC Attribution 4.0
Submitted: 05 July 2023 | Published: 05 February 2024

About the author(s)

Saif H. Alrasheed, Department of Optometry, College of Applied Medical Sciences, Qassim University, Buraidah, Saudi Arabia; and Department of Binocular Vision, Faculty of Optometry and Visual Sciences, Al-Neelain University, Khartoum, Sudan
Sulaiman Aldakhil, Department of Optometry, College of Applied Medical Sciences, Qassim University, Buraidah, Saudi Arabia


Background: Fusional vergence amplitude is the amount of convergence and divergence that can be induced before fusion is lost and fusional vergence amplitude controls heterophoria.

Aim: This study aimed to investigate the relationship between near heterophoria, near fusional vergence (NFV), and near point of convergence (NPC).

Setting: Al-Neelain Eye Hospital Khartoum, Sudan.

Methods: A hospital-based prospective study from February to October 2019, included 230 patients with age range of 15–30 years and mean age and standard deviation of 19.46 ± 3.33 years. The alternate cover test with prism was used to measure near heterophoria and a prism bar was used to measure quantity of fusional vergence. All measurements were taken at near heterophoria (0.33 m). Then the associations between near heterophoria, NFV and NPC were assessed.

Results: The most common heterophoria at near among the participants was exophoria: 200 (87.0%). Reported complaints of asthenopia were commonly found among these exophoric patients: 106 (86.9%) (P = 0.735). Positive fusional vergence (PFV) to the break point varied according to the forms of heterophoria (P = 0.003). Esophoria had a higher PFV to break point than exophoria (30.83 ± 8.79Δ compared to 25.59 ± 10.07Δ). Negative fusional vergence at the break and recovery points were higher among those with exophoria and lower in esophoria (P ˃ 0.05). The NPC differed by the type of heterophoria (P = 0.01), with exophoria and slightly receded NPC (8.38 cm ± 3.33 cm) than for participants with esophoria (6.77 cm ± 1.52 cm).

Conclusions: Exophoria was the most common type of near heterophoria, with asthenopia being the most reported complaint. Esophoria was found to be strongly associated with high PFV. Exophoria, on the contrary, is related to significant high NFV at the blur, beak, and recovery point. The NPC differed significantly by the type of near heterophoria, with exophoria having more receded NPC compared to those with esophoria.

Contribution: This study provides information on the commonest type of near heterophorias among a sample of Sudanese adolescents and young adults, namely exophoria. Near point of convergence and NFV at break and recovery points were significantly different according to forms of near heterophoria.


heterophoria; esophoria; exophoria; positive and negative fusional vergence; diplopia

Sustainable Development Goal

Goal 3: Good health and well-being


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