The Role of Aberrometry in Accommodative Spasm After Myopic Photorefractive Keratectomy.

Abstract

To report the role of aberrometry in a case of accommodative spasm following myopic photorefractive keratectomy (PRK). Observational case report. One month following myopic PRK, a 33-year-old healthy woman complained of seeing multiple images and headache that interfered with her daily activities. Her corrected distance visual acuity (CDVA) was 20/40 in the right eye and 20/25 in the left eye with a manifest refraction of -0.75 -0.50 × 165° in the right eye and plano -0.50 × 20° in the left eye. Cycloplegic refraction was plano -0.50 × 165° in the right eye and plano -0.5 × 20° in the left eye. Ray tracing aberrometry showed variable refraction with increase in internal defocus, which after cycloplegia reduced from 1.019 to 0.142 µm in the right eye and 0.366 to 0.230 µm in the left eye. Total ocular aberrations decreased by 53.16% in the right eye (range: 1.511 to 0.708 µm) and 18.77% (range: 0.671 to 0.545 µm) in the left eye; corresponding simulated Snellen visual acuity charts also showed improvement. The patient was treated with one drop of cyclopentolate 1% three times a day for 6 weeks, following which headache and ghosting of images completely resolved. Accommodative spasm should be considered in patients with visual disturbances of uncertain causes following myopic refractive surgery. Ray tracing aberrometry can serve as a diagnostic and educative tool in managing such patients.