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.

Is 0.01% Atropine an Effective and Safe Treatment for Myopic Children? A Systemic Review and Meta-Analysis

Several conflicting results regarding the efficacy of 0.01% atropine in slowing axial elongation remain in doubt. To solve this issue and evaluate the safety of 0.01% atropine, we conducted a systematic review and meta-analysis with the latest evidence. The review included a total of 1178 participants (myopic children). The efficacy outcomes were the mean annual progression in standardized equivalent refraction (SER) and axial length (AL). The safety outcomes included mean annual change in accommodative amplitude, photopic and mesopic pupil diameter. The results demonstrated that 0.01% atropine significantly retarded SER progression compared with the controls (weighted mean difference [WMD], 0.28 diopter (D) per year; 95% confidence interval (CI) = 0.17, 0.38; p < 0.01), and axial elongation (WMD, −0.06 mm; 95% CI = −0.09, −0.03; p < 0.01) during the 1-year period. Patients receiving 0.01% atropine showed no significant changes in accommodative amplitude (WMD, −0.45 D; 95% CI = −1.80, 0.90; p = 0.51) but showed dilated photopic pupil diameter (WMD, 0.35 mm; 95% CI = 0.02, 0.68; p = 0.04) and mesopic pupil diameter (WMD, 0.20 mm; 95% CI = 0.08, 0.32; p < 0.01). In the subgroup analysis of SER progression, myopic children with lower baseline refraction (>−3 D) and older age (>10-year-old) obtained better responses with 0.01% atropine treatment. Furthermore, the European and multi-ethnicity groups showed greater effect than the Asian groups. In conclusion, 0.01% atropine had favorable efficacy and adequate safety for childhood myopia over a 1-year period.

Optometric Screening of Elementary Students in Greece

Background: The aim of this study is to provide a wide screening test in elementary school students in Greece in order to trace undiagnosed visual deficiencies, which can affect the visual performance and efficiency. Methods: Examination procedures were approved by the Ministry of Education for the optometric team to enter the school premises and perform the assessments. The researchers performed optometric testing according to standard protocols to evaluate visual acuity (VA), near point of convergence (NPC), accommodative amplitude and facility, vergence facility, stereopsis, and pursuit and saccade oculomotor function. Results: The 835 students that were examined came from a total number of 14 schools so as to enable social stratification of high, medium, and low living standards. Fewer than 17% of the children managed to pass all visual tests at published goal levels. Testing identified a significant number of students who had undiagnosed visual deficiencies (83%). Conclusion: Visual Function in elementary students needs to be evaluated on a regular basis following a comprehensive Optometric screening so that a wide range of visual dysfunctions can be detected. Our ultimate goal is to ensure adequate conditions for every student to develop vision skills needed to meet academic demands.

Effect of low-dose atropine on myopia progression, pupil diameter and accommodative amplitude: low-dose atropine and myopia progression

PurposeTo evaluate the effects of 0.01% and 0.02% atropine eye drops on myopia progression, pupil diameter and accommodative amplitude in myopic children.MethodsA cohort study assessed 400 myopic children divided into three groups: 138 and 142 children were randomised to use either 0.02% or 0.01% atropine eye drops, respectively. They wore single-vision (SV) spectacles, with one drop of atropine eye drop applied to both eyes once nightly. Control children (n=120) only wore SV spectacles. Repeated measurements of spherical equivalent refractive errors (SERs), axial length (AL), pupil diameter and accommodative amplitude were performed at baseline, and 4, 8 and 12 months after treatment.ResultsAfter 12 months, the SER change was −0.38±0.35D, −0.47±0.45D, −0.70±0.60D and AL change was 0.30±0.21 mm, 0.37±0.22 mm, 0.46±0.35 mm in the 0.02%, 0.01% atropine and control groups, respectively. There were significant differences in the change in AL and SER between three groups (all p<0.001). Between baseline and the 12-month visit, the overall change in accommodative amplitude was 1.50±0.25D, 1.61±0.31D and change in pupil diameter was 0.78±0.42 mm, 0.69±0.39 mm, with 0.02% and 0.01% atropine, respectively. Accommodative amplitude significantly decreased and pupil diameter significantly increased in two atropine groups (all p<0.001). Moreover, there was no statistical difference in the change difference in accommodative amplitude and pupil diameter between two atropine groups (p=0.24, p=0.38), whereas the accommodative amplitude (p=0.45) and pupil diameter (p=0.39) in the control group remained stable.Conclusions0.02% atropine eye drops had a better effect on myopia progression than 0.01% atropine, but 0.02% and 0.01% atropine showed similar effects on pupil diameter and accommodative amplitude after 12 months of treatment.Trial registration numberChiCTR-IPD-16008844.

Evaluation of accommodative function in the dominant and non dominant eye

Background: Ocular dominance is the physiological preference of one eye over the other, hence its input is favoured when there is conflicting information to the two eyes. Accommodation is the mechanism by which the eye changes focus from distant to near images and is produced by a change in the shape of the crystalline lens. The aim of this study was to compare the accommodative amplitude, facility and lag in the dominant and non-dominant eye.Methods: This cross sectional study was carried out on 80 visually normal subjects. Ocular dominance was determined using hole-in-the- card method. Amplitude of accommodation, accommodative facility and response was measured monocularly and randomly using push up method, ±2.00DS flipper lenses and Nott technique respectively.Results: Results obtained from the study showed that the right eye was dominant in 62.5% of subjects. The mean (SD) for accommodative amplitude, facility and response (lag) in the dominant eye was 11.08 (2.16) D, 10.00 (1.52) cycles per minute and 0.62 (0.27) respectively. The mean (SD) for accommodative amplitude, facility and lag in the non-dominant eye was 10.98 (2.20) D, 9.86 (1.44) cycles per minute and 0.60 (0.25) D respectively.Conclusions: It may be inferred that the dominant eye has more accommodative amplitude, facility and lag than the non-dominant eye but this difference was not statistically significant.