Estimation of accommodation in early childhood: Targets and preliminary results

Accommodative disorders can be found in a variety of patients of the pediatric ophthalmology age group. Detection and measurement of (insufficient) accommodation is necessary for adequate management of these patients. Dynamic retinoscopy reversal was used to estimate the accommodative amplitude. Subjective point of blur was compared in two groups of healthy and ophthalmologically normal preschool children: (1) six weeks to one year, (2) one year to six years, in comparison to a group of (3) five years to 12 years, who underwent two different tests. Four targets, mounted on a hand-held occluder, are introduced and tested, 1-3 showing different, more or less detailed and fine drawings of faces, 4 showing a grating of lower spatial frequency with a center of high spatial frequency. The subjective near point for the targets was also tested and compared in 12 young adults (16 to 31 years). The finest drawing appeared to be most adequate for reproducing the closest near point in young adults. This also applies for children above 2% years, while younger children showed better performance and more constant fixation with roughly outlined, schematic drawings of a smiling face. The grating was met with no (babies below two months) or little interest (older infants). The amplitude of accommodation seemed less good with the grating in preschool children. Thus, dynamic retinoscopy is an adequate method to estimate the amplitude of accommodation in early childhood, and the drawing of a smiling face on a 5 cm target is an adequate stimulus attracting attention and accommodation of preverbal children and even babies.