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.

Prevention of accommodation disorders and myopia in children

Background. An important role in the structure of ophthalmic pathology is played by myopia, especially rapidly progressing in adolescence, and accommodation disorders, which are, in fact, the precursors and companions of myopia. The purpose was to prevent accommodation disorders and mild myopia in children of different age groups by using dietary supplements Doppelherz® Kinder Eye vitamins with lutein and Doppelherz® Kinder Glycine. Materials and methods. One hundred and three children of diffe-rent age groups underwent functional examination against the background of treatment: group I — primary school age, prepubertal period (6–11 years) — 24 children, group II — middle school age, pubertal period (12–18 years) — 79 children, 24 of them had problems of the neck and collar zone associated with computer load. Standard examination methods were used. Results. After the course of the proposed therapy, the Haidinger’s phenomenon decreased to 5.70 ± 0.01 conventional units (p < 0.05) in the first group; up to 4.60 ± 0.03 conventional units in 55 children of the second group without problems in the neck and collar zone and up to 5.40 ± 0.02 conventional units in 24 children who had such problems (p < 0.02). Conclusions. Using Doppelherz® Kinder Eye vitamins with lutein and Doppelherz® Kinder Glycine improves the functioning of the ciliary muscle. Under the influence of treatment, visual acuity and accommodation reserves increased, and the power of optical correction decreased. The positive influence of Doppelherz® Kinder Eye vitamins with lutein and Doppelherz® Kinder Glycine on the increase in the functional activity of the fovea-afferent system and the accommodative function of the visual analyzer in spasm of accommodation and mild myopia has been proven.

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.

Blur Detection Sensitivity Increases in Children Using Orthokeratology

PurposeTo investigate changes in blur detection sensitivity in children using orthokeratology (Ortho-K) and explore the relationships between blur detection thresholds (BDTs) and aberrations and accommodative function.MethodsThirty-two children aged 8–14 years old who underwent Ortho-K treatment participated in and completed this study. Their BDTs, aberrations, and accommodative responses (ARs) were measured before and after a month of Ortho-K treatment. A two forced-choice double-staircase procedure with varying extents of blur in three images (Tumbling Es, Lena, and Street View) was used to measure the BDTs. The participants were required to judge whether the images looked blurry. The BDT of each of the images (BDT_Es, BDT_Lena, and BDT_Street) was the average value of the last three reversals. The accommodative lag was quantified by the difference between the AR and the accommodative demand (AD). Changes in the BDTs, aberrations, and accommodative lags and their relationships were analyzed.ResultsAfter a month of wearing Ortho-K lenses, the children’s BDT_Es and BDT_Lena values decreased, the aberrations increased significantly (for all, P ≤0.050), and the accommodative lag decreased to a certain extent [T(31) = 2.029, P = 0.051]. Before Ortho-K treatment, higher-order aberrations (HOAs) were related to BDT_Lena (r = 0.463, P = 0.008) and the accommodative lag was related to BDT_Es (r = −0.356, P = −0.046). After one month, no significant correlations were found between the BDTs and aberrations or accommodative lags, as well as between the variations of them (for all, P ≥ 0.069).ConclusionOrtho-K treatment increased the children’s level of blur detection sensitivity, which may have contributed to their good visual acuity.

Smartphone induced eye strain in young and healthy individuals

Background: Usage of digital devices has become one's basic need. Digital eye strain is repeatedly noticed sequelae in optometry practice. Objectives: This study aims to estimate the different aspects of eye strain. Methodology: Altogether, 55 students with a mean age of 21.25 years, vision (≥6/9) were enrolled. A survey related to common asthenopic (eyestrain) symptoms was carried before and after reading an extract from a novel. Accommodative facility and non-invasive first tear breakup (NTBUT) time were measured before and after the reading. The viewing distance to a smartphone was measured every 20 minute. Results: The total eye strain symptom score was significantly greater post-experiment (score = 7.07±2.84) than pre-experiment (score = 1.54±1.60, p < 0.001). Symptoms of tired eyes, sore eyes, and sleepy eyes increased significantly after 60 min of a smartphone use (p < 0.05). The mean viewing distance while using a smartphone over 60 min was 30.15 ± 3.29 cm. There was a significant correlation between change in total symptom score and change in viewing distance (r = ˗0.301, p = 0.026). The symptom that correlated with a change in viewing distance was ‘sore eyes’ (r = ˗0.382, p = 0.04) and sleepy eyes (r= ˗0.363, p=0.06). There was a significant decrease in monocular and binocular accommodative facilities and NTBUT after 60 min of reading. Conclusion: Closer viewing distance and eyestrain symptoms are obvious after a smartphone reading. Prolonged use of smartphones appears to have important implications for accommodative function, causing ocular symptoms having an impact on quality of life.

Changes in accommodative function following small-incision lenticule extraction for high myopia

Purpose To examine whether the amplitude of accommodation, the accommodative response, and the accommodative facility is affected and correlated with changes in higher-order aberrations for patients with high myopia surgically treated with small-incision lenticule extraction (SMILE). Methods 35 highly myopic eyes (myopic spherical equivalent of at least 6 diopters) of 35 patients treated with SMILE were included. Assessments were made before and 3 months after surgery. Donders push-up-method was used to measure the amplitude of accommodation. The accommodative response was assessed using an open-field autorefractor”Grand Seiko WAM-5500” (Grand Seiko Co. Ltd., Hiroshima, Japan) in combination with a Badal optometer and stimuli of accommodation at 0.0, 0.5, 1.25, 2.0, 3.0, and 4.0 D, respectively. Accommodative facility was measured at 40 cm with ±2,00D flipper lenses. All measurements of accommodation were performed monocularly with the refractive error corrected with soft contact lenses. Results The amplitude of accommodation did not change statistically significantly (mean difference -0.24 D (SD 0.98), 95% CI of mean difference -0.58 D to 0.11 D, paired-sample t(34) = -1.39; P = 0.17). The accommodative responses at 0.0, 0.5, 1.25, 2.0, 3.0, and 4.0 D did not statistically significantly change either (F(6,29) = 1.15; P = .36). Finally, the accommodative facility was also unchanged with a mean difference of 1.11 cycles per minute (SD 5.11, 95% CI of mean difference -0.64 to 2.87, paired-sample t(34) = 1.29; P = 0.21). No clinically significant associations between changes in accommodation and higher-order aberrations were found. Conclusions SMILE does not alter the amplitude of accommodation, the accommodative response, nor the accommodative facility for highly myopic patients, and the surgically induced corneal higher-order aberrations do not affect the accommodative function.