Contact lenses vs spectacles in myopes: is there any difference in accommodative and binocular function?

Background  

Theoretically, the accommodative and vergence demands are different between single-vision contact lenses and spectacle lenses. The aim of the present study was to determine whether these differences exist when these two correction methods are used in clinical practice. For this, different visual parameters that characterize the accommodative (accommodation amplitude, accommodative facility, and accommodative response) and binocular function (near and distance horizontal and vertical dissociated phorias, near and vertical associated phorias, near and distance negative and positive fusional vergence, vergence facility, near point of convergence, negative and positive relative accommodation, stimulus AC:A ratio and stereoacuity) were evaluated in a student population when their myopia was corrected with either spectacles or soft contact lenses (SCL).     

A longitudinal study of vergence adaptation in incipient presbyopia

BACKGROUND: To investigate vergence adaptation during the incipient phase of presbyopia, when the amplitude of accommodation approaches the level where the first reading addition is required. The study aimed to assess the ability of the vergence system to counteract changes in the component contributions to the overall vergence response with the decline in the amplitude of accommodation in presbyopia, although previous reports on the nature of changes in accommodative, tonic and proximal vergence are equivocal. METHODS: Using a 'flashed' Maddox rod technique, an assessment of vergence adaptation to 6delta base-out and 6delta base-in prism was made for 28 subjects (aged 35-45 years at the commencement of the study). The measurements were taken four times over a 2-year period. RESULTS: Using a repeated measures analysis of variance, the results show that with the decline in amplitude of accommodation, there is a statistically significant reduction in the magnitude of vergence adaptation to both base-out (p < 0.05) and base-in prism (p < 0.01). CONCLUSIONS: This study shows that with ageing, there is a decrease in the ability of the slow vergence mechanism to overcome a change in fusional vergence demand and would suggest that either the fast component of fusional vergence must cope with any change in fusional vergence demand or that the sum of the accommodative, tonic and proximal vergence responses are virtually stable with age.     

Short-term adaptation of accommodation,accommodative vergence and disparity vergence facility

Previous studies have found that subjects can increase the velocity of accommodation using visual exercises such as pencil push ups, flippers, Brock strings and the like and myriad papers have shown improvement in accommodation facility (speed) and sufficiency (amplitude) using subjective tests following vision training but few have objectively measured accommodation before and after training in either normal subjects or in patients diagnosed with accommodative infacility (abnormally slow dynamics). Accommodation is driven either directly by blur or indirectly by way of neural crosslinks from the vergence system. Until now, no study has objectively measured both accommodation and accommodative–vergence before and after vision training and the role vergence might play in modifying the speed of accommodation. In the present study, accommodation and accommodative–vergence were measured with a Purkinje Eye Tracker/optometer before and after normal subjects trained in a flipper-like task in which the stimulus stepped between 0 and 2.5 diopters and back for over 200 cycles. Most subjects increased their speed of accommodation as well as their speed of accommodative vergence. Accommodative vergence led the accommodation response by approximately 77 ms before training and 100 ms after training and the vergence lead was most prominent in subjects with high accommodation and vergence velocities and the vergence leads tended to increase in conjunction with increases in accommodation velocity. We surmise that volitional vergence may help increase accommodation velocity by way of vergence–accommodation cross links.     

Accommodation,convergence and aging

It is generally believed that the ratio of accommodative convergence to accommodation (AC/A ratio) is relatively constant with age. This is based on studies of what is known as the AC/A stimulus ratio in which the denominator is the accommodative stimulus value. However, if the objective accommodative response to each stimulus is used instead in the denominator, then the ratio, called the AC/A response, is not constant but shows an increase beginning just prior to presbyopia. This suggests that greater effort is necessary for a unit of lens accommodation when one gets older or conversely a given effort produces less and less accommodation with age. The disparity between AC/A stimulus and AC/A response is discussed with reference to clinical presbyopia.Supported in part by GRANT #EY00191 of the National Eye Institute.A preliminary report was presented at the New York Academy of Medicine, Ophthalmology Section, May 20, 1968.     

Reliability of the response AC/A ratio determined using nearpoint autorefraction and simultaneous heterophoria measurement

Background : Clinicians frequently assess the accommodative convergence to accommodation (AC/A) ratio using near phoria measurements and accommodative stimuli. The purpose of this study was to evaluate the repeatability of AC/A ratio measurements and to compare the response AC/A ratio to stimulus AC/A ratios determined two different ways. Methods : Heterophorias and accommodative responses to different stimuli were measured simultaneously on eight subjects at two visits. A Canon Auto Ref R-1 autorefractor was used to measure accommodative response, while vergence posture was measured using the modified Thorington heterophoria technique. These results were used to calculate response-slope, stimulus-slope and stimulus-gradient AC/A ratios and the means of these ratios for each session were compared. Correlations between the response AC/A ratios and the stimulus AC/A ratios were calculated. Results : The mean response AC/A ratios for the two sessions were 3.8 prism dioptres per dioptre for each session. The correlation between the slope-determined ratios was 0.56, and between the response-slope and the stimulus-gradient AC/A ratios the correlation was -0.03. The regression equation for the slope-determined AC/A ratios was calculated.     

Statistical normal values of visual parameters that characterize binocular function in children

A wide range of visual parameters used to evaluate binocular function were evaluated in a paediatric population (1056 subjects aged 6-12 years). Mean values are provided for these ages in optometric tests that directly assess the vergence system, horizontal phorias for near and far vision (measured by a modified version of the Thorington method), negative and positive vergence amplitude for near and far vision (step vergence testing), vergence facility (flippers 8 Delta BI/8 Delta BO), and near-point of convergence (penlight push-up technique and red-lens push-up technique), as well as stimulus accommodative convergence/accommodation ratio and stereoacuity (Randot test) which provide an overall evaluation of the vergence, accommodative and oculomotor systems. A statistical comparison (anova and Bonferroni post hoc test) of these values between ages was performed. The differences, although statistically significant, were not clinically meaningful, and therefore we identified two trends in the behaviour of these parameters. For all parameters, except for vergence facility, we established a single mean reference value for the age range studied. The difference between the means for vergence facility indicated the need to divide the population into two age ranges (6-8 and 8-12 years). This study establishes statistical normal values for these parameters in a paediatric population and their means are a valuable instrument for separating children with binocular anomalies from those with normal binocular vision.     

Stimulus and response AC/A ratios in intermittent exotropia of the divergence-excess type.

Objective infrared recording devices were used to measure simultaneously and continuously both accommodation and accommodative vergence to near stimuli in 4 subjects with intermittent exotropia of the divergence-excess type (2 simulated and 2 true). In addition standard clinically determined stimulus accommodative convergence to accommodation (AC/A) ratios were measured. Results showed the mean group response AC/C ratio to be 5.9/1 (range 4.5-8.0/1) with no differences between true and simulated divergence-excess. Similar AC/A ratios were found after 45 minutes of monocular occlusion. Our results clearly demonstrate relatively normal response AC/A ratios in these subjects. Thus, contrary to what is believed by many clinicians, the reduced ocular deviation at near compared with distance vision cannot be attributed primarily to an abnormally high AC/A ratio. We believe than fusional convergence after-effects and/or proximal convergence effects contribute to inflate the clinically determined stimulus AC/A ratios.     

Effects of persistent viewing of 3 D TV on human visual function

目的:研究持续观看3D电视对视功能的影响,以及探索不同视功能参数之间的关系.方法:本研究录入19位受试者,每位受试者观看90分钟的2 D电视或90分钟的3 D电视,两部电视观看间隔时间为一周,顺序随机.每次观看电视前及观看后15 min内都做相关视功能检查,检查包括以下四种视功能参数:调节功能(调节反应、调节微波动、调节灵敏度、正相对调节、负相对调节、AC/A),融像性聚散功能(远距负融像性聚散功能、远距正融像性聚散功能、近距负融像性聚散功能、近距正融像性聚散功能),隐斜量(远距隐斜量、近距隐斜量),立体视.结果:无论是与观看前的基础值比较,还是与观看2D电视后的数据比较,观看3D电视后近距离调节反应增加,汇聚减少,远距隐斜量向外隐斜改变(P<0.05).结论:持续观看3D电视会对人们的视功能有一定影响,主要是打破了调节和聚散系统的平衡.厂家和公众应该引起重视,将调节功能、融像性聚散功能、隐斜量等参数作为评估3D电视安全性的指标.     

The first and second order dynamics of accommodative convergence and disparity convergence

Main sequences, the function describing the relationship between eye movement amplitude and velocity, have been used extensively in oculomotor research as an indicator of first-order dynamics yet it is difficult to find main sequence analyses for accommodative vergence or for disparity vergence in isolation when all mitigating factors have been well controlled and there are no studies in which accommodative vergence and disparity vergence main sequences have been generated for the same group of subjects. The present study measured main sequences in: (1) accommodative vergence with disparity vergence open loop, (2) disparity vergence with accommodation open loop, and (3) combinations of accommodative and disparity vergence. A dynamic AC/A ratio was defined and was found to be similar to the traditional static AC/A ratio. Vergence acceleration was measured for all conditions. A pulse-step model of accommodation and convergence was constructed to interpret the dynamics of the crosslinked interactions between the two systems. The model supports cross-coupling of both the pulse and step components and simulates the primary empirical findings that: (1) disparity vergence has a higher main sequence slope than accommodative vergence, (2) both accommodative and disparity vergence acceleration increase with response amplitude whereas accommodation acceleration does not.     

Evidence that convergence rather than accommodation controls intermittent distance exotropia

Purpose: This study considered whether vergence drives accommodation or accommodation drives vergence during the control of distance exotropia for near fixation. High accommodative convergence to accommodation (AC/A) ratios are often used to explain this control, but the role of convergence to drive accommodation (the CA/C relationship) is rarely considered. Atypical CA/C characteristics could equally, or better, explain common clinical findings. Methods: Nineteen distance exotropes, aged 4-11?years, were compared while controlling their deviation with 27 non-exotropic controls aged 5-9?years. Simultaneous vergence and accommodation responses were measured to a range of targets incorporating different combinations of blur, disparity and looming cues at four fixation distances between 2?m and 33?cm. Stimulus and response AC/A and CA/C ratios were calculated. Results: Accommodation responses for near targets (p?=?0.017) and response gains (p?=?0.026) were greater in the exotropes than in the controls. Despite higher clinical stimulus AC/A ratios, the distance exotropes showed lower laboratory response AC/A ratios (p?=?0.02), but significantly higher CA/C ratios (p?=?0.02). All the exotropes, whether the angle changed most with lenses ('controlled by accommodation') or on occlusion ('controlled by fusion'), used binocular disparity not blur as their main cue to target distance. Conclusions: Increased vergence demand to control intermittent distance exotropia for near also drives significantly more accommodation. Minus lens therapy is more likely to act by correcting overaccommodation driven by controlling convergence, rather than by inducing blur-driven vergence. The use of convergence as a major drive to accommodation explains many clinical characteristics of distance exotropia, including apparently high near stimulus AC/A ratios.     

Age-related changes in static accommodation and accommodative miosis

An attempt was made to explore the validity of the Hess-Gullstrand and Duane-Fincham models of presbyopia development, on the assumption that accommodative miosis could be used as an indicator of ciliary muscle effort. Monocular accommodation response and pupil size were measured as a function of accommodation demand over the range 0-4 D, in 48 normal subjects with ages between 17 and 56 years. The slope of the response/stimulus curve was found to decrease only slowly with age up to about 35 years and then to decline more rapidly. Accommodative miosis per dioptre of accommodation response did not change systematically with age up to about 35 years, this being apparently more in accord with the Hess-Gullstrand model. However, accommodative miosis varied very widely between younger subjects of similar age and accommodative amplitude (from zero to around 1 mm per dioptre of accommodation response for subjects in their twenties). It is concluded that miosis does not necessarily accompany accommodation and that its magnitude is not related in any simple general way to ciliary muscle contraction. Hence it cannot be used to support or refute particular theories of presbyopia.     

Accommodation characteristics before and after near work

Accommodation measurements on 32 young subjects using a polarised vernier optometer showed that the mean accommodation response/stimulus curve within an accommodative amplitude of 6.67 D followed a linear trend. Statistical analysis showed a significant link between the dark focus and optimum focus (accommodative response equals stimulus demand) but not between the dark focus and gain (slope). The distance refractive state shows a weak correlation with gain but not with the dark focus. These findings suggest that near vision adaptation results in dark focus adaptation which modifies closed-loop accommodation responses through its influence with the position of optimum focus.     

Orthoptic Treatment in Patients with Inertia of A ccommodation

ABSTRACT A retrospective analysis of the records of 14 patients diagnosed as having inertia of accommodation has been completed. The patients were most likely to report blurred near vision, facility of accommodation problems, headaches and asthenopia. In addition to a sluggish accommodative system, the accommodative amplitudes were slightly less than expected for the patient's age, the near point of convergence slightly extended and the fusional vergences slightly reduced. With orthoptic training, the facility and amplitude of accommodation and the recovery finding for the near positive fusional vergence were found to have improved significantly. Most patients (90%) obtained some relief with treatment, and 30% achieved a total alleviation of the difficulties. The condition and current state of treatment of inertia of accommodation are briefly discussed.     

Changes in the Accommodation-convergence Relationship after the Artisan Phakic Intraocular Lens Implantation for Myopic Patients

Purpose

To evaluate the change of accommodation-convergence parameters after implantation of Artisan phakic intraocular lens (PIOL).

Methods

Prospective study for the patients with the Artisan PIOL implantation was performed. A total of 37 patients (3 males and 34 females) enrolled the study. Preoperatively, convergence amplitude, the stimulus accommodative convergence per unit of accommodation (AC/A) ratio and the near point of convergence (NPC) were evaluated. After the Artisan PIOL implantation, the identical evaluations were repeated at 1 week, 1, 3, and 6 months after the surgery.

Results

Mean age was 24.3 ± 4.8 years old, and preoperative refractive error was -8.92 ± 4.13 diopters (D). After the implantation, mean refractive errors significantly decreased to within ±1.00 D, and noticeable complications were not found. The convergence amplitude and the stimulus AC/A ratio increased 1 month after the surgery, but progressively stabilized afterward to near preoperative values. NPC didn''t show any significant change over follow-up period up to 6 months.

Conclusions

These results regarding implantation of the Artisan PIOL revealed the increase of accommodation-convergence relationship within first 1 month after the surgery, but progressive stabilization was noted during follow-up periods.     

Clinical method for measuring adaptation of tonic accommodation and vergence accommodation

Previous work indicates that tonic adapters of accommodation and vergence have indirect effects on accommodative vergence and vergence accommodation and that these crosslink responses interact with one another to produce clear and single vision. Clinical measurements of tonic accommodation, tonic vergence, vergence accommodation (CA/C ratio), and accommodative vergence (AC/A ratio) are therefore of value in determining possible binocular vision abnormalities. Currently, clinical methods are only available for measuring the tonic vergence (phoria) and the AC/A ratio. We have determined a fast and accurate method for evaluating both tonic accommodation (accommodative phoria) and vergence accommodation (CA/C ratio). In both procedures, the loop of accommodation was opened with a 0.2 cpd difference of Gaussian (DOG) target. This target was found to be incapable of stimulating any reflex accommodation, yet it is localized in space and can easily stimulate binocular fixation. Our results indicate that opening the loop of accommodation with a pinhole Maxwellian view or with a 0.2 cpd DOG produces similar response values for tonic accommodative aftereffects and vergence accommodation responses. The decay rate of tonic accommodative aftereffects as well as changes in the resting focus of accommodation caused by vergence accommodation (CA/C) can be measured clinically using dynamic retinoscopy in combination with the DOG target. Clinical values of the CA/C ratio obtained with these techniques were highly correlated (r = 0.92) with laboratory measures obtained with an objective infrared optometer and eye trac monitor.     

The effect of stimulus duration on tonic accommodation and tonic vergence

Changes in tonic accommodation and tonic vergence were studied as a function of stimulus duration and time after near fixation. Thirteen visually normal young adults each participated in experimental sessions comprising each of 12 combinations of stimulus type (accommodative or vergence) and stimulus duration (0.25, 0.5, 1, 2, 4, or 8 min). During each session, measurements were made of either tonic accommodation or tonic vergence 30 s before stimulus onset and at 0.5, 2, 4, 6, 8, 10, 12, and 14 min after stimulus offset. The stimulus (a high contrast reduced Snellen visual acuity chart) was viewed monocularly at the accommodative nearpoint and binocularly through pinholes at the fusional nearpoint on the accommodative and vergence sessions, respectively. For tonic accommodation, stimulus duration had no significant effect on either the magnitude of the aftereffect or its rate of decay. For tonic vergence however, the aftereffect was larger and had a slower rate of decay as stimulus duration increased. The results suggest that the adaptive mechanisms within the two systems have different time constants.     

The use of video refraction to measure the dynamic properties of the near triad in observers of a 3-D display

OBJECTIVE: Recording of the dynamic behaviour of the near triad during viewing of a three-dimensional (3-D) display is attempted. This may then be used to identify the possible origin of asthenopia and other ocular problems which occur whilst viewing such displays. METHODS: Subjects viewed a 3-D display through an image splitter. Video recordings of ocular responses (pupil diameter, vergence and accommodation) were made with a commercially available video refraction unit at a distance of 1.2 m from the subject. Continuous recordings were made whilst a step-wise disparity of up to 2.6 degrees was introduced between the targets presented to the two eyes, but the accommodative stimulus remained unchanged. Image analysis from the recordings was carried out on a personal computer. RESULTS: Results showed various complex patterns of response, with the accommodation and vergence recorded reflecting the effect of stimulus conflict. Difficulty in fusional convergence was recorded when disparity was large, and the recordings reflected the subjects' comments. CONCLUSION: The video refraction method is a useful tool for studying the dynamic behaviour of the near triad.     

Dynamic interactions between accommodation and convergence are velocity sensitive

Aftereffects of accommodation and vergence occur following approximately 1 min of adaptation to lenses and prisms respectively. This observation can be interpreted to mean that accommodation and vergence responses have phasic and tonic components. We have examined the role that these proposed subcomponents play in mutual interactions between accommodation and vergence. Both accommodative vergence (AV) and vergence accommodation (VA) were unresponsive to low temporal frequency variations (less than 0.1 Hz) in defocus and disparity respectively. However, both AV and VA were responsive to higher temporal frequency stimuli (up to 0.5 Hz). When negative feedback to the stimulated system was cancelled electronically, both AV and VA become responsive to low temporal frequency stimuli. The ratio or gain of accommodative vergence/accommodation (AC/A) and vergence accommodation/vergence (CA/C) increased nonlinearly with stimulus amplitude. Vergence aftereffects resulted from stimulation of AV and accommodative aftereffects resulted from stimulation of VA. These results are interpreted to mean there could be a complementary relationship between the amplitude of the AC/A ratio and proposed tonic adaptation of accommodation, and between the amplitude of the CA/C ratio and proposed tonic adaptation of vergence. A low saturation limit or stimulus window for tonic adaptation may account for the amplitude dependent nonlinearities of the AC/A and CA/C ratios.     

Response AC/A ratios are elevated in myopic children

In children little is known about the relationship between the AC/A ratio and the development of myopia, although they have been linked in adults. The purpose of this study was to investigate the interaction between accommodation and convergence and its relationship to refractive errors in children. Accommodation was measured for the right eye using the Canon R-1 autorefractor, and concomitant changes in vergence were assessed using a Maddox rod and a Risley prism before the left eye. Thirty-three myopic and 68 emmetropic children were tested wearing best subjective correction while looking at a distant (4.0 m) letter array and a near (0.33 m) one through additional plus and minus lenses. Lens-induced and distance-induced response AC/A ratios were calculated from the data. Both types of AC/A ratios are elevated in myopic children, who show reduced accommodation and enhanced accommodative convergence. Myopic children with esophoria underaccommodate at near. This suggests that a child who is esophoric must relax accommodation to reduce accommodative convergence and maintain single binocular vision. The reduction in accommodation could produce blur during near work, which could induce myopia as in animal models.     

Dynamic accommodation and myopia.

PURPOSE: Accommodative effort during nearwork is thought to be a causative factor in the development of myopia. It has been proposed that an anomaly in autonomic control may be a precursor to the development of myopia. In the present study the closed-loop accommodation response after variations in fixation period was investigated in emmetropes, early-onset myopes and late-onset myopes to determine characteristics of reflex accommodation for each refractive group. METHODS: Closed-loop accommodation responses were measured in a group of emmetropes (n = 7), early-onset myopes (n = 7), and late-onset myopes (n = 7) by use of a dynamic tracking infrared optometer. A variation in fixation period (10 seconds, 60 seconds, and 180 seconds) before an accommodative step was used to stimulate the accommodation control mechanism differentially. RESULTS: Group results of accommodative response times showed that late-onset myopes were significantly affected by the duration of fixation before the change in stimulus vergence. Accommodative response times after 3 minutes of sustained near vision were significantly longer than those observed for other groups for the near-to-far condition. Reaction time appears to be independent of refractive grouping, prior fixation period, and direction of step change. CONCLUSIONS: Late-onset myopes showed significantly extended accommodation response times after a sustained near vision task that was demonstrable under well-controlled experimental conditions. The extended response times observed in the present study were consistent with previous reports of refractive shifts in late-onset myopes and early-onset myopes and provide a corollary between reflex and adaptive components of the accommodation response. Potential mechanisms are discussed in an attempt to explain the resultant hysteresis under closed-loop viewing conditions.