Abstract
Aim: To compare the subjective near point of accommodation measurement with the RAF rule using the conventional (clear to blur) and modified (blur to clear) push-up methods. Methods: Both methods of testing the near point of accommodation were carried out uniocularly and binocularly in 32 visually normal participants (mean age: 20.08) with a range of visual experience. Results: The modified push-up method (blur to clear) gave a near point of accommodation further away from the subject. A difference of 0.51 cm in the right eye, 0.61 cm in the left eye and 1.05 cm binocularly was found between the two methods which was statistically significant ( p < 0.05). No difference was found between nai¨ve and expert groups ( p < 0.05). However, most participants reported that the end point was easier to judge with the modified method. Conclusion: Despite being significantly different statistically, the difference between the two methods measuring the near point of accommodation with the RAF rule was small. The findings support the use of the modified method of measuring the near point of accommodation with the RAF rule, rather than the conventional method.
Highlights
Accommodation is the ability of the lens to change its refractive power in order to focus on objects placed at different distances.[1]
The conventional push-up method resulted in near point of accommodation measurements that were slightly closer to the participants than those from the modified method
The near point of accommodation measurements from both methods are shown in Table 1 and Fig. 1
Summary
Accommodation is the ability of the lens to change its refractive power in order to focus on objects placed at different distances.[1]. The most common method in orthoptic clinical practice is a subjective measurement of the near point of accommodation using the Royal Air Force (RAF) rule. The near point of accommodation is the point nearest the subject that can be seen clearly[5] and it can be measured in two different ways using the RAF rule, both of which rely on accurate and reliable subjective responses. The conventional push-up method has been used for over a century,[6] during which a clear target is gradually moved closer to the subject until they report the point at which the target starts to blur. It should be recognised that the point of first blur will be slightly closer to the subject than the actual near point of accommodation
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