Testing Accommodation in Children

Accommodation disorders are associated with a host of etiologies. Children with accommodative disorders can present with various symptoms including blur, fluctuating vision, eye pain, burning sensation, tired eyes, asthenopia, headaches, fatigue with near work, and excessive rubbing, blinking, or tearing. This chapter provides an overview of accommodation testing on pediatric patients in the clinical setting. The author describes the indications for accommodation testing and provides clinical pearls for testing accommodative function in children. The chapter covers the specific tests, equipment required, and step-by-step procedures for testing accommodative amplitude, accommodative response, and accommodative facility.

Comparative analysis of accommodative ability in children with hyperopia, anisometropia, amblyopia after femtolaser-assisted laser intrastromal keratomileusis

Purpose. Analysis of the accommodative ability in children with hyperopic anisometropia, amblyopia of operated amblyopic and paired leading eyes after femtolaser-assisted laser intrastromal keratomileusis (FS-LASIK). Material and methods. In the 1st group were 20 children with hyperopic anisometropia and amblyopia after FS-LASIK. In the 2nd were children receiving conservative treatment. Results. After 6 months, when analyzing the accommodation, the coefficient of the accommodative response (CAR) of amblyopic eye in the 1st group was 0.05±0.07 conv. units, in the 2nd group was -0.1±0.19 conv. units (рm-u=0.03). The microfluctuation coefficient (CMF) of the amblyopic eye was increased, but the CMF of the paired leading eye in children after FS-LASIK approached the norm and amounted to 58.4±5.4 µF / min. In the conservative treatment group CMF remained high and was 60.8±4.44 µF / min (рm-u= 0.08). The objective accommodative response of the amblyopic eye in the 1st group increased by -1.13±0.03 diopters, in the 2nd group – by -0.82±0.48 diopters (рm-u=0.05). Conclusion. FS-LASIK helps to improve the accommodative ability in children with hyperopia, anisometropia and amblyopia. Key words: accommodation, hyperopia, anisometropia, amblyopia, FS-LASIK.

Quantification of Pupillary Dynamics and Accommodative Response in Adie’s Tonic Pupil: A Case Report

Background: Objective quantification of pupillary dynamics in a clinical setting is of worth importance to rule out any pupillary abnormalities. However, despite normal binocular vision findings, a quantitative measurement of pupillary response and accommodation provides a better insight to understand the mechanism. Case Report: This case report illustrates the clinical presentation, binocular vision parameters, Pupillary dynamics and accommodative response in a 33-year-old diagnosed with Adie’s Tonic pupil following trauma. Conclusion: This report explains the role of the pupillometer and open field autorefractor in quantitative analysis of pupillary and accommodative function.

Reduction in Accommodative Response of Schoolchildren by a Double-Mirror System

Purpose: This study first proposed the application of a double-mirror system (DMS) to extend viewing distance and investigate the accommodative response of schoolchildren under a DMS. Method: Fifty-seven subjects aged between 7 and 12 years old were recruited in this study, and the experiment was divided into two stages. The first stage consisted of a case history inquiry, a refraction state, and a visual function examination. In the second stage, the subjects gazed at an object at distances of 0.4 m, 2.285 m, and through a DMS, respectively, and their accommodative responses were measured using an open-field autorefractor. Results: There was no significant difference in the schoolchildren’s accommodative response between subjects gazing at an object at 2.285 m (0.14 ± 0.35 D, p > 0.05) and those gazing at it through a DMS (0.20 ± 0.35 D). However, their accommodative response showed a significant difference between subjects gazing at an object at 0.4 m and 2.285 m and those gazing at it at 0.4 m and through a DMS. Conclusion: In this experiment, the results of the children’s accommodative response measured at 2.285 m or through a DMS are very similar. The viewing distance can be extended by a DMS, resulting in accommodative relaxation. This result may have potential applications in myopia control.

Impact of life activity in conditions of digital environment on the students’ organ of sight

The growth of eye disease incidence in the juvenile population amidst increasing visual load, which, among other factors, results from the use of electronic devices (ED), outlines the search for effective preventive measures, geared towards preservation of health of young people. The study was aimed to assess the impact of life activity upon exposure to digital environment on the organ of sight in schoolchildren and college students. The study was carried out in 2017-2020 at Dolgoprudny gymnasium and Pirogov Russian National Research Medical University. A total of 805 schoolchildren and college students underwent ophthalmologic examination. Accommodative response was registered with Speedy-K Ver. MF-1 autorefractor keratometer (Japan). A standardized questionnaire, tailored by the authors to meet the requirements of the study, was used to assess the regime for the use of ED by students. Inclusion criteria: schoolchild, college student, ophthalmologic examination data and submitted informed consent available, correctly completed questionnaire. Statistical processing was performed using the Statistica 13.0 software. All students were the ED owners. Only 9.9% of primary school students, 2.7% of secondary school students, 1.9% of senior secondary school students, and 0.9% of college students did not use ED every day. Significant negative correlation was revealed between the students’ vision acuity and the daily total time of using the ED, as well as the duration of the ED continuous use (р≤0.05). Accommodation weakness was detected in 88.76% of students with early stage of myopia; accommodative response close to normal was less common (11.24%). The increase in daily total time of using the ED by 2 hours and more results in higher prevalence of functional vision problems (p≤0.05), and the trend of increasing the number of high myopia cases. The data obtained define the need of improving the students’ hygiene training starting from the preschool age.

Analysis of Accommodation Gain of Presbyopia Eye After Laser Ablation (or Shrinkage) of Sclera Via Lens Reshaping and Lens Anterior Shift

Purpose: To derive and provide analytic formulas for an accommodative gain of presbyopia eyes. via sclera ablation and/or thermal shrinkage such that the lens is reshaped and/or its position is shifted. New mechanisms are also proposed. Study Design: To increase the accommodation of presbyopia. Place and Duration of Study: New Taipei City, Taiwan, between June 2021 and July 2021. Methodology: Accommodation gain is calculated by a 4-component theory, in which the rate functions are derived by an effective eye model for the change of anterior curvature of the lens and its anterior shift. The measured data of accommodative response of the lens versus the lens curvature change and anterior shift are analyzed. The measured net change of the posterior vitreal zonules (PVZ) length and the space between the ciliary body and lens (CLS) during the accommodation are also analyzed. Results: The accommodative gain (AG) is mainly due to the change of lens anterior curvature and its anterior shift. The AG per diopter change of the reshaped lens is 0.62 to 0.68 by our formulas, comparing to the measured average value M'=0.69.The efficacy of LASA (or AG) is proportional to the amount of scleral tissue removed (or shrinkaged), such that more space is produced for the change of PVZ and CLS from a UCS to AS for accommodation. Conclusion: The AG is proportional to the amount of scleral tissue removed (or shrinkaged), such that more space is produced for the change of PVZ and CLS from a UCS to AS for accommodation.