Fig. (1) Patient with acquired vertical accommodative vergence. (a) fixating at distance and refracted for distance*, (b) fixating at near and refracted for distance, (c) fixating at distance with an addition of -3 D to distance refraction, and (d) fixating at near with an addition of +3 D to distance refraction. *(a) may indicate right hypotropia and exotropia. However, the corneal light reflex has the same height in both eyes in relation to the upper pupillary margin. This may be difficult to see as the upper part of the right iris appears darker than in left eye. With regard to a possible horizontal deviation one has to keep in mind that the patient was fixating at distance while being photographed from 1m explaining the nasal displacement of the light reflex.