Is the inability to clear plus lenses on BAF and MAF more characteristic of Accommodative Insufficiency or Accommodative Excess?

• A. Accommodative Insufficiency
• B. Accommodative Excess
• C. Convergence Excess
• D. Divergence Excess

Answer: (B)

Accommodative facility tests how readily the eyes can change focus. When plus lenses are added, the eyes must relax accommodation to keep the target clear. If the accommodative system is overactive or in a spasm—accommodative excess—the eyes have trouble relaxing, so plus lenses are not cleared efficiently on both Binocular and Monocular Accommodative Facility tests. This pattern is the hallmark of accommodative excess. By contrast, accommodative insufficiency is a problem with stimulating accommodation, so difficulty typically appears with minus lenses that require increasing focus, not with plus lenses. Vergence excess conditions involve eye alignment rather than the relaxation of accommodation, so they don’t explain poor plus-lens clearing on these tests.