Abstract
BackgroundPseudomyopia is caused by increased refractive power by ciliary muscle spasm. Most patients cannot overcome pseudomyopia spontaneously; therefore, treatment of pseudomyopia is fastidious and needs a multidisciplinary approach. We report a case of unusual pseudomyopia with paradoxical accommodation, straining eyes to induce emmetropia at far distance and relaxing eyes to focus at near objects, contrary to physiological accommodation.Case presentationA 33-year-old woman experienced intermittent distant vision discomfort. This occurred at least a few hundred times daily. She could see near objects clearly; however, distant objects could be seen clearly only when she strained her eyes. Uncorrected distance visual acuity was 20/20 and manifest refraction (MR) in both eyes in the relaxed state was approximately − 2.5 D. MR changed to approximately − 0.5 D when she grimaced and strained her eyes when attempting to focus on distant letters. Her response was contrary to the physiological accommodative response. Cycloplegic refraction was approximately 0.0 D. Binocular autorefractor/keratometer was used to objectively evaluate her refractive response and pupil reaction according to accommodative stimulation. The IOL Master was used to evaluate the anterior chamber depth (ACD), lens thickness (LT), and pupil diameter with relaxed and strained eyes. For stepwise static accommodative stimuli (1–5 D), the refractive responses were correspondingly stepwise, similar to those elicited by healthy individuals. However, contrary to physiological accommodation, she strained her eyes to see distant objects and relaxed them to see near objects. There was no change in pupil diameter despite the accommodative stimuli being maximum. Biometry results showed that ACD deepened and LT flattened with eye strain, which were contrary to those during physiological accommodation.ConclusionsWe report a rare case with reverse of physiological accommodative response. When patients complain of unusual distant visual discomfort, pseudomyopia with paradoxical accommodation should be considered.
Highlights
Pseudomyopia is caused by increased refractive power by ciliary muscle spasm
Pseudomyopia, can occur separately, and result in blurred distance vision due to increased refractive power generated by ciliary muscle spasm, asthenopia, and headache
Biometry results indicated that anterior chamber depth (ACD) deepened and lens thickness (LT) flattened with maximal eye strain, compared with relaxed eyes, and her pupil diameter showed no significant change (Table 1)
Summary
Accommodation involves changing the optical power to sharply focus on objects placed at varying distances. Basic blood test showed no abnormalities, brain imaging test was not performed due to cost Her refractive response and pupil change to accommodative stimulations were objectively evaluated with a WAM-5500 binocular autorefractor/keratometer (Grand Seiko Co. Ltd., Hiroshima, Japan). Cycloplegic refraction (CR) in the right eye and left eye was − 0.26 D and 0.13 D, respectively (Fig. 1a) Her pupil diameter was approximately 4 mm, without any significant difference in size while gazing at a distant or near object (KruskalWallis test, P = .59) (Fig. 1b). Biometry results indicated that ACD deepened and LT flattened with maximal eye strain, compared with relaxed eyes, and her pupil diameter showed no significant change (Table 1) These results were contrary to the physiological movements of ACD and LT. She has provided informed consent for publication of the case
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