Objective Accommodation Research Articles

Application of a New Device for Vision Relaxation in Computer Users.

This study aims to explore the potential of a novel EYE ROLL device designed to facilitate guided vision relaxation exercises in an open space. A prospective study was performed on 89 participants who perform screenwork for at least four hours daily. All participants were randomly divided into three groups: a Control group with no exercising, a Manual group undertook manual vision relax ation exercises, and an Eyeroll group engaged in EYE ROLL device-assisted vision relaxation exercises. Each participant underwent three evaluations (an initial baseline assessment, a 4-week follow-up, and an 8-week follow-up) with four assessment tools: a comprehensive vision examination, an in-depth questionnaire, saccadic eye movement recordings, and objective accommodation measurements. There was a statistically significant decrease (35% and above) in complaint scores at the 4-week follow-up in both training groups. Although statistically insignificant, complaints continued to decrease after an 8-week period. No significant changes were observed in clinical or objective accommodative parameters. Some variation of visual functions was observed in all groups due to repeated measures. Vision relaxation exercises combined with proper vision ergonomics and working habits can reduce asthenopic complaints. The EYE ROLL device presents a promising tool for integrating these exercises into the working environment.

BCLA CLEAR Presbyopia: Evaluation and diagnosis

It is important to be able to measure the range of clear focus in clinical practice to advise on presbyopia correction techniques and to optimise the correction power. Both subjective and objective techniques are necessary: subjective techniques (such as patient reported outcome questionnaires and defocus curves) assess the impact of presbyopia on a patient and how the combination of residual objective accommodation and their natural DoF work for them; objective techniques (such as autorefraction, corneal topography and lens imaging) allow the clinician to understand how well a technique is working optically and whether it is the right choice or how adjustments can be made to optimise performance. Techniques to assess visual performance and adverse effects must be carefully conducted to gain a reliable end-point, considering the target size, contrast and illumination. Objective techniques are generally more reliable, can help to explain unexpected subjective results and imaging can be a powerful communication tool with patients. A clear diagnosis, excluding factors such as binocular vision issues or digital eye strain that can also cause similar symptoms, is critical for the patient to understand and adapt to presbyopia. Some corrective options are more permanent, such as implanted inlays / intraocular lenses or laser refractive surgery, so the optics can be trialled with contact lenses in advance (including differences between the eyes) to better communicate with the patient how the optics will work for them so they can make an informed choice.

The first experience of parallel measurements of objective accommodation parameters in children with myopia using various instruments: in search of a common denominator

Purpose: to study the relationship between the parameters of reflex and tonic accommodation measured using various objective methods.Material and methods. A comprehensive parallel study of objective accommodation parameters of 57 children (114 eyes) with low and moderate myopia (average -2.6 ± 1.4 D) aged from 8 to 12 years (average 9.9 ± 1.6 years) was carried out on three devices: Grand Seiko WAM-5500K, Acomoref 2 K-model Righton; TONOREF III, Nidek.Results. Both coincidences and differences of the indicators obtained by different methods as well as their correlations were revealed: positive - between the values of AR in the open field and in the virtual space (r = 0.23, r = 0.2); between the virtual responses to Righton K-2 and Nidek (r = 0.38); direct correlations of the accommodation response with accommodation tones. A correlation of average strength (r = 0.44) was found between the HAT on the Grand Seiko WR-5100K and the CMF on the Righton K2, which allows us to consider them as synonymous indicators. A negative relationship of CMF with PRA and SE refraction was found. A positive correlation of CMF with the rate of progression of myopia and a negative one with PRA suggests that a high CMF is a bad prognostic sign. However, CMF positively correlates with the magnitude of the accommodative response on all three devices. In this case, it turns out that an increase in CMF accompanies an increase in the amplitude of accommodation and, therefore, is not always a troublesome factor. Perhaps we are dealing with the limits of the norm for this indicator, which still need to be studied.Conclusion. With the help of objective methods of studying qualitatively different characteristics of one process, it is possible to investigate the actual and prognostic parameters of accommodation, which will allow us to offer an individualized approach to the treatment of patients with myopia using optical and drug instruments.

Dynamics of Accommodative Asthenopia in Patients with Visually Intense Work after LASIK with Different Degrees of Myopia

Purpose — to study the dynamics of accommodative asthenopia (AA) in patients with visually stressful labor (VLT) after laser keratomileusis in situ (LASIK) with different degrees of myopia. Patients and methods. There were 300 patients with VLT under supervision, divided into three groups of equal age and gender, corresponding to weak (up to 3.0 diopters, 100 patients, 200 eyes), medium (3.25–6.0 diopters, 100 patients, 200 eyes) and high (6.25–8.0 diopters, 100 patients, 200 eyes) degrees of myopia. All patients underwent objective accommodation using the Righton Speedy-I device (Japan) with further calculation of the coefficient of microfluctuations of the ciliary muscle of the eye (CMF). Diagnosis of the type of AA was carried out according to the following indicators: with CMF less than 53.0 rel. un. — asthenic form of accommodative asthenopia (AFAA); at CMF from 53.0 to 58.0 rel. un. — NORM; at CMF more than 58.0 rel. un. — habitual excess tension of accommodation (PINA). The survey was carried out before and three months after the operation. Statistical analysis of the results of the study was performed on the basis of the rate of occurrence (in % of the total number of eyes) of different dynamics (before-after surgery) AA (NORM-NORM; PINA-PINA; AFAA-AFAA; NORM-AFAA; NORM; PINA-AFAA; AFAA-NORM; AFAA-PINA). Results. The change in the form of AA varied from 2 % (APAA-PINA) to 18 % (PINANORM), averaged 15 % and was not statistically significant. The results obtained naturally reflect the state of AA as an adequate physiological response of the accommodative system of the eye to long-term, intense visual work with a fairly high level of responsibility for the result. Based on the above situation and the patient’s desire to maintain (in some cases even increase) the volume of daily visual load after the operation, it is unlikely to expect a significant improvement in the state of accommodation. Conclusion. LASIK with different degrees of myopia in patients with VLT has practically no effect on the dynamics of AA and requires a complex of therapeutic and restorative measures based on the development of methodological principles from the standpoint of a differentiated approach to the form of AA and the basic provisions of medical rehabilitaton.

Dynamic Stimulation Aberrometry: Objectively Measured Accommodation and Pupil Dynamics after Phakic Iris-Fixated Intraocular Lens Implantation

Anterior iris-claw phakic intraocular lens (pIOL) implantation is a treatment option for refractive, ametropic patients. However, the postoperative accommodative ability has not been systematically researched. Dynamic stimulation aberrometry allows the objective and dynamical measurement of accommodation by observing ocular aberrations during the accommodation process. We investigated the dynamic accommodative ability after pIOL implantation compared with a healthy age- and gender-matched control group. Clinical, comparative case-control study. We included patients aged 18-50 years that either underwent pIOL implantation > 1 month ago or served as a healthy, phakic control group. The accommodative ability and pupil dynamics of both groups were investigated using dynamic stimulation aberrometry. The method allows the analysis of dynamic parameters during accommodation, such as the accommodation speed. A 1:1 propensity score matching was conducted based on the patients' age and gender. Parameters of objective accommodation, such as accommodative amplitude and pupil dynamic during accommodation. Fifty-eight healthy, phakic eyes < 50 years of age and 21 eyes after pIOL implantation to correct myopia (pIOL, Verisyse, AMO, Inc) were enrolled. Patients that underwent anterior pIOL implantation were examined on average 24 ± 18 months after surgery. After matching, the mean age of both groups was not significantly different (35 ± 8 vs. 34 ± 8 years). No significant difference in dynamic parameters of accommodation or the accommodative amplitude (2.8 ± 1.4 and 2.9 ± 1.4 diopters [D] for pIOL and control group, P= 0.82) were seen. Maximum and minimum pupil sizes were not significantly different. The change in pupil size during deaccommodation was significantly faster in patients after pIOL implantation (P < 0.001). Dynamic stimulation aberrometry allowed the objective, dynamic, measurement of wavefronts in subjects with accommodative amplitudes up to 7 D. Phakic intraocular lens implantation does not impair the accommodative ability. It alters pupil dynamics during deaccommodation. Proprietary or commercial disclosure may be found after the references.

The Relationship of Various Forms of Accommodative Asthenopia with the Characteristics of the Professional Activity in Patients with Visually Intense Work and the Phenomena of Computer Visual Syndrome

Purpose: to study the relationship of various forms of accommodative asthenopia (AA) with the characteristics of the professional activity of patients with visually stressful work (VSW) with the phenomena of computer visual syndrome (CVS).Methods. There were 150 patients with VSW — professional users of personal computers (mean age 28.8 ± 1.4 years) with myopic refraction (mean value of spherical equivalent 2.8 ± 1.1 diopters) under observation. The patients were divided into three groups: “normal” (50 patients); asthenic form of accommodative asthenopia (AFAA, pathology, 50 patients); habitual excessive tension of accommodation (HETA), pathology, 50 patients). All patients underwent a comprehensive ophthalmological examination for 13 parameters. As a basic diagnostic method, a specially developed questionnaire aimed at assessing professional activity was used. Statistical analysis of the results of the study was performed on the basis of an assessment of the average values of the correlation coefficients (ACC) between the patient’s responses (in points) and the studied indicators of the visual system.Results. High ACC were determined on issues characterizing the amount of daily visual load. However, no differences were found between APAA and HETA. The occurrence of AFAA is more often associated with the input of information, HETA — with reading. Evaluation of issues related to the regularity of the use of optical correction revealed differences in ACC (p &lt; 0.05) between the “normal” group and the “pathology” groups, while in the “normal” group, optical correction was used in most cases “often” or “constantly”, in the “pathology” groups — “sometimes”.Conclusion. The results of the correlation assessment of the relationship between various types of AA in patients with VSW with the characteristics of professional activity and the parameters of the visual analyzer indicate the leading role of the duration and nature (input, reading of information) of daily work at a personal computer. One of the leading risk factors for the development of AA is inadequate optical correction. At the same time, there were no significant differences between AFAA and PINA. The most informative parameters of the accommodative system of the eye are the volume of absolute and relative accommodation (by the subjective method), as well as the coefficients of microfluctuations and stability of accommodogram (by the objective accommodation method).

Excimer Laser Correction of Myopia in Patients with Visually Intense Work — Is It Necessary to Determine the Form of Accommodative Asthenopia?

Рurpose — to study the frequency of occurrence of various forms of accommodative asthenopia (AA) in patients with visually stressful work (VSW) with different degrees of myopia planning LASIK.Methods. As part of the preoperative examination, 300 patients with VSW were under observation. There were three groups of equal age and gender, corresponding to weak (up to 3.0 diopters, 100 patients), moderate (3.25–6.0 diopters, 100 patients ) and high (6.25–8.0 diopters, 100 patients) degrees of myopia. All patients underwent objective accommodation using the Righton Speedy-I device (Japan) with further calculation of the coefficient of microfluctuations of the ciliary muscle of the eye (KMF). Diagnosis of the type of AA was carried out according to the following indicators: with KMF less than 53.0 rel. un. — asthenic form of accommodative asthenopia (AFAA), pathology; at KMF from 53.0 to 58.0 rel. — norm; at KMF more than 58.0 rel.un. — Habitual Excessive Tension of Accommodation (HETA), pathology.Results. The incidence of AA (any form) was 51–57 % and weakly depended on the degree of myopia. A significant increase (compared with the literature data) in patients with AA according to the results of this work is due to the following factors: the examination of patients exclusively with VSW, who daily perform professional visual activity at the time of the examination, as well as a wide (24–34 years) the age range of the subjects. The probability of occurrence of HETA and AFAA is quite comparable and amounted to 29–36 % and 21–23 %, respectively. The obtained results are illustrated by typical accomodograms. Conclusion: the high incidence of both forms of AA actualizes further research aimed at assessing the dynamics of the state of the accommodative system of the eye after excimer laser surgery for myopia, as well as the development of a method for correcting AA, taking into account a personalized approach that allows performing the correct diagnosis of various forms of AA (HETA, AFAA), which, ultimately, will provide adequate treatment from the position of choosing both the actual method (physical factor) and the required optical, amplitude and time parameters of exposure.

Accommodation disorders in patients with visually intensive labor before LASIK in myopia (clinical cases)

Laser keratomileusis in situ (LASIK) is the most common refractive surgery in young patients, the goal of which is to provide high distance vision without the use of glasses. One of the topical aspects of assessing the clinical effectiveness of LASIK is the dynamics of the accommodative function of the eye, which is a professionally significant function of the visual analyzer in patients with visually stressful work (VSW). Three clinical cases are presented, reflecting various states of accommodation (normal, habitual excessive tension of accommodation, asthenic form of accommodative asthenopia), diagnosed (based on the method of objective accommodation and the "quality of life" questionnaire "Computer visual syndrome — 22" in patients with VSW before LASIK. It was determined that that LASIK for various degrees of myopia in patients with VSW requires a comprehensive consideration from the standpoint of diagnosis and (or) correction of accommodative asthenopia based on a personalized approach that takes into account the main types of asthenopia. Correct diagnostics provides adequate treatment from the standpoint of choosing both the actual method (physical factor) and the required optical, amplitude and time parameters of exposure.

Modern aspects of diagnosis and treatment of subjective manifestations and accommodation disorders in patients — professional users of personal computers (systematic review)

A systematic review was performed in the RSCI and PubMed databases using the following keywords: Computer vision syndrome, Digital eye strain, Accommodation, Accommodative asthenopia, RTS, and Quality of life. Eligible articles were evaluated in accordance with the criteria for prospective or retrospective studies. A total of 792 sources were analyzed, further using systematic review filters and authors knowledge of the topic. The retrospective analysis spanned 7 years (20162022). Data indicated that accommodative asthenopia (AA), as a functional visual disorder, is a natural state of the accommodative system of the eye caused by long-term exposure to visually intense work on a personal computer. AA is characterized by a wide range of subjective manifestations (complaints) and indicators of the examination of the patients vision, associated primarily with objective accommodation. A differentiated approach to the diagnosis of various forms of AA, such as habitual excessive stress of accommodation and asthenic form of accommodative asthenopia, is important to provide adequate treatment based on methods with direct physical effects on the eye (such as low-energy laser radiation, magnetophoresis, and stimulation of accommodation), opto-reflex treatment, and an outpatient course as part of home training.

Предикторы аккомодационной астенопии у пациентов зрительно-напряженного труда с явлениями компьютерного зрительного синдрома

Purpose. Investigation of the relationship between the indicators of the visual system of patients with visually stressful labor (VLT) and the diagnostic criteria for accommodative asthenopia (AA). Material and methods. 300 patients were examined (mean age 29.4 ± 1.2 years, the presence of myopia in terms of spherical equivalent value (SE) from 1.5 diopters to 8.0 diopters), whose professional daily activities (at least 2 years) are characterized by as VLT with a personal computer (PC). A comprehensive examination of the state of vision was performed according to clinical, functional, subjective and ophthalmo-ergonomic indicators. A multiple regression analysis of 18 indicators of the functional state of the visual analyzer was performed with the parameter of objective accommodation – the coefficient of microfluctuations (CMF) as the basic diagnostic criterion for AA. The assessment of the level of reliability of the mathematical model (regression equation) was based on the calculation of the multiple coefficients of determination (R2). Results. The high (R2 = 0.71) predictive value of the developed mathematical model was determined. It has been established that CMF is closely interconnected (p &lt; 0.05–0.001) with clinical (uncorrected distance visual acuity, SE), functional (indicators of objective accommodography — coefficients of accommodative response, accommodogram growth, etc.), subjective (questionnaire «quality life» «KZS-22») and ophthalmo-ergonomic («Eye» test in conditions of time deficit of presentation of the test object) parameters of the functional state of the visual analyzer. The low information content of traditional methods for studying accommodation indicators (the volume of absolute and relative accommodation) has been determined. Conclusion. The identified parameters can be considered from the standpoint of predictors of accommodative asthenopia in patients with VLT associated with PC. At the same time, the leading indicator of screening diagnostics can be a study of the patient’s «quality of life» according to the «KZS-22» questionnaire, which allows clinically normalizing accommodation disorders from the standpoint of the states of «normal», «subcompensation» and «decompensation» of asthenopia. Keywords: visually stressful work, computer vision syndrome, accommodative asthenopia, objective accommodography, «quality of life»

Introducing Dynamic Stimulation Aberrometry: Binocular Objective Accommodation versus Subjective Measures

The objective measurement of binocular accommodation remains a challenge. The dynamic stimulation aberrometry (DSA) system uses wavefront measurements to dynamically assess accommodation. In this study, we sought to introduce this method in a large number of patients of varying age and compared it with the subjective push-up method as well as the historical results of Duane. This study is an evaluation of diagnostic technology. Ninety-one patients aged 20 to 67 years (70 healthy, phakic eyes and 21 myopic eyes after phakic intraocular lens implantation) were enrolled at a tertiary eye hospital. All patients underwent DSA measurements; the accommodative amplitude of 13 patients chosen at random was additionally examined using the subjective push-up method introduced by Duane. DSA measurements were also compared with Duane's historical results. Accommodative amplitude, dynamic parameters of accommodation, and near pupil motility. Dynamic stimulation aberrometry allowed objective measurement of binocular accommodation, which decreased with age (e.g., 30-39 years vs. > 50 years; 3.8 ± 0.9 diopters [D] and 0.1 ± 0.4 D, respectively). Dynamic parameters, such as time delay of the commencement of accommodation after near target presentation, increased with age (0.26 ± 0.14 seconds for 20-30 years vs. 0.43 ± 0.15 seconds for 40-50 years, P= 0.0002). The objective accommodative amplitude was significantly smaller than Duane's historic results (P= 0.001) as well as the subjective push-up method. Dynamic stimulation aberrometry records pupil motility dynamically in parallel to wavefront measurements. Maximum pupil motility during accommodation significantly decreased with age (P= 0.0002). Maximum pupillary speed did not correlate significantly with age. Dynamic stimulation aberrometry allows objective, dynamic, binocular measurement of accommodation and pupil motility with high time resolution in subjects with accommodative amplitudes up to 7 D. This article introduces themethod in a large study population and may serve as a control for further studies. Proprietary or commercial disclosure may be found after the references.

Comparison of subjective and objective accommodation amplitude values

Aim: Comparison of accommodation amplitude values measured using autorefractometer, push up and minus lens technique.&#x0D; Material and Method: In this randomized, prospective study, both eyes of 75 healthy individuals between the ages of 15 and 40 were included in the study. They were divided into 5 groups as 15-20 age group 1, 21-25 age group 2, 26-30 age group 3, 31-35 age group 4, 36-40 age group 5 To measure the accommodation amplitude, the minus lens and push up technique were used as subjective methods, and the autorefractometer Tonoref III was used as the objective. The correlation between the measurement methods and the reproducibility of the autorefractory measurements were evaluated. In addition, changes in accommodation measurements with age, gender and pupil diameter changes were investigated.&#x0D; Results: The mean accommodation amplitude values were 4.86±1.73 D in the minus lens technique, 8.79±4.58 D in the push up technique, and 2.77±1.93 D in the autorefractometer measurement. Autorefractometer accommodation amplitude values were found to decrease significantly with age (p=0.000). It was seen that the correlation between autorefractometry and subjective methods, minus lens and push up was significant and correlated (p=0.000, r=0.47, p=0.001, r=0.28, respectively). Intraclass correlation coefficients of Tonoref III accommodation amplitude were found to be 0.935.&#x0D; Conclusion: Objective accommodation amplitude measurements made using Tonoref III were found to be correlated with subjective methods, but lower values were detected compared to subjective methods.

Quantification of scleral changes during dynamic accommodation

The mechanics of accommodation is a complex process that involves multiple intraocular ocular structures. Recent studies suggest that there is deformation of the sclera during accommodation that may also play a role in accommodation, influencing ciliary muscle contraction and contributing to the accommodative response. However, the type and magnitude of the deformations measured varies significantly across studies. We present high-resolution synchronous OCT measurements of the anterior sclera contour and thickness and lens thickness acquired in real-time during accommodative responses to 4D step stimuli. The lens thickness was used as an assessment of objective accommodation. No changes in nasal and temporal anterior scleral contour and scleral thickness were found during accommodation within the precision of our measurements. Our results demonstrate that there are no significant scleral deformations during accommodation.

Long-term results of orthokeratology correction combined with 0.01 % atropine instilliations in children and adolescents with progressive myopia of various degrees

Purpose. To evaluate the effectiveness of control of myopia of various degrees in children and adolescents with the combined use of orthokeratology (OK) correction and ultralow-dose atropine instillations (0.01 %) over a long-term follow-up period (up to 3 years). Material and methods. Children and adolescents aged 11.0–13.5 with continuing progression of acquired myopia who wore nocturnal OK lens (OKL) were divided into three groups according to the duration of 0.01 % atropine application: group 1 comprised 58 children (116 eyes) who received the treatment for 6 months, group 2, 34 children (68 eyes), 8 months, group 3, 145 children (290 eyes), 36 months. The patients were examined before their OK-correction was supplemented by 0.01 % atropine instillations and every 6 months after it. The examination included visometry, refractometry, determination of reserves of relative accommodation reserve (RAR), objective accommodation response, pseudo accommodation (PA), measurement of axial length by optical biometry, anterior biomicroscopy, assessment of lens conditions; ophthalmoscopy under maximum mydriasis using binocular ophthalmoscope. Results. With atropine instillations, the yearly progression rate of myopia (YPR) in group 1 significantly decreased (by 1.6 times). the best effect showing in mild and moderate myopia. In group 2, after 18 months’ follow-up, YPR had significantly decreased (by 2.2 times). In group 3, after a 36 months’ observation, the maximum, 2.8-fold decrease in YPR was observed. The most marked and significant, 3.5-fold decrease in progression rate was observed in low myopia. In moderate myopia, the inhibitory effect of the combination of OKL/atropine combination showed a significant increase as the treatment duration became longer. In high myopia, progression rate fell insignificantly in the first 6 months, but over the whole period of observation, YPR showed a statistically significant, 1.6-fold decrease as compared to the initial level. RAR and PA remained at the levels they were before atropine instillations. Conclusion. OK correction combined with 0.01% atropine instillations produces a pronounced inhibitory effect in children with the most unfavourable course of myopia – progression continuing with night-time orthokeratology. The most pronounced effect was obtained in mild to moderate myopia. The longer the treatment period, the greater the effect of myopia stabilization. Over the 36 months’ period, 0.01% atropine showed no negative effect on the quality of visual functions of subjects wearing OK lenses.

Short-term results of wearing spectacle lenses with embedded rings of highly aspherical lenslets Stellest™ for myopia control

Purpose: to evaluate near visual work performance of those wearing spectacles with Stellest™ lenses and the impact of their continuous wear on refraction changes, accommodation and binocular interaction after 6 months from the start of use. Material and methods. 35 children aged 8-13 with myopia of 3.15 ± 0.19 D were prescribed eyeglasses with Stellest™ lenses. 32 children with myopia of 2.68 ± 0.18 D who used monofocal glasses served as control. Visual performance, refraction, axial length (AL), accommodation and binocular interaction were assessed. Results. According to the Burdon test, the number of errors in counting letters in Stellest™ glasses was 4.5 ± 0.64, whilst in monofocal glasses it was- significantly less, 2.96 ± 0.42 (p &lt; 0.05); the rate of test progress was the same in the two groups. After 6 months from the start of wearing Stellest™ glasses, the objective cycloplegic refraction increased by 0.11 ± 0.04 D, the average year progression rate (YPR) was 0.22 ± 0.08 D. In contrast, the children wearing monofocal glasses showed an average refraction increase of 0.35 ± 0.05 D, and the average YPR value of 0.7 ± 0.09 D. In the Stellest™group, YPG drop was observed in 87 % of cases and averaged 0.95 ± 0.11 D. In the control group, YPR was found to drop in 65 % of cases and averaged 0.49 ± 0.1 D. In the Stellest™ group, AL increased by 0.04 ± 0.02 mm; in the control group, the increase in AL was 2.8 times greater — by 0.11 ± 0.02 mm (p &lt; 0.01). In the Stellest™ group, relative accommodation reserves (RAR) increased by 0.88 ± 0.14 D, which is significantly higher than in the group wearing monofocal glasses, where the increase was 0.39 ± 0.12 D (p &lt; 0.01). No differences were revealed between the groups in objective indicators of accommodation and binocular interaction. Conclusion. Wearing spectacles with Stellest™ lenses for 6 months contributes to slowing down the progression of myopia in children. Over the observation period, the refraction increase in the main group was 3.2 times lower than in the control group, whilst AL growth was 2.8 times lower than that in the control group. The children using spectacles with Stellest™ lenses showed a higher increase in RAR as compared to children wearing monofocal spectacles. The accommodation tone and objective accommodation parameters were essentially the same in both groups. Wearing Stellest™ glasses had no pronounced effect on binocular interaction.

The effect of phenylephrine hydrochloride 2.5 % and sodium hyaluronate solution on visual functions and accommodation in children with myopia and its local tolerability

Purpose: to evaluate visual functions, accommodation, and local tolerance in children instilled with Phenylephrine hydrochloride 2.5 % and sodium hyaluronate solution (Stelphrin Supra). Material and methods. 30 children (60 eyes) aged 8 to 12 (ave. 10.04 ± 0.24) with low (28 eyes) and moderate (32 eyes) myopia (ave. -2.96 ± 0.17 D) were tested. Refractometry, subjective and objective accommodation, optical biometry, anterior corneal surface examination, Norn test, and polling were performed prior to one-time instillation, 30 minutes after it, and after 1 month of daily bedtime instillations of Stelphrin Supra. Results. We noted a significant decrease in the tone of accommodation in the open field by 90 % from the initial value, an approximation of the nearest point of clear vision by 27 %, an increase in the volume of absolute accommodation by 57 % and the objective amplitude of accommodation by 20 %, which indicates an increase in the accommodation ability. The pupil width increased 30 minutes after a single instillation of Stelphrin Supra, which coincided with an increase in the relative accommodation reserve by 25 % from the initial one. After a month, the pupil width significantly decreased, and the positive relative accommodation reserve decreased to a level only 12 % higher than the original one. Tear film break time significantly increased by 0.89 sec, singular spot stainings disappeared in 2 out of 6 patients, lacrimation — in 6 out of 10, pain — in 1 out of 2, blurring in 4 out of 6, feeling of “sand” — in 7 out of 9 patients who had these symptoms before instillations. Conclusion. Regular instillations of Stelphrin Supra reduce the habitual tone of accommodation, increase the accommodation ability, and improve the condition of the eye surface.

Quality of life of a patient with computer vision syndrome depending on the type of accommodative astenopia

Purpose: a comparative assessment of the quality of life (QOL) of patients with symptoms of computer vision syndrome (CVS), depending on the type of accommodative asthenopia: habitual excessive accommodation stress (HEAS) and the asthenic form of accommodative asthenopia (AFAA). Material and methods. 60 patients aged 22–34 engaged in visually extensive work who had typical asthenopic complaints were examined. The main criterion for diagnosing the type of asthenopia was the coefficient of ciliary muscle microfluctuation, measured by objective accommodation on a Righton Speedy-I device (Japan). The patients were divided into two groups of 30 people each with similar age and sex distribution, corresponding to the two forms of asthenopia studied. The main method of QOL examination was the study of an innovative CVS-22 questionnaire filled in by the testees. Results. The comparative assessment of the overall test indicator revealed no significant differences between the examined groups of patients with HEAS (QOL = 40.2 ± 1.2 pts) and AFAA (QOL = 42.2 ± 1.0 pts), p &gt; 0.05. For some of the complaints, certain differences were found, partly associated with the pathogenesis of HEAS and AFAA, however, they do not fully reflect the “specificity” of the main types of accommodative asthenopia. Conclusion. The results obtained indicate the absence of reliable subjective diagnostic criteria of CVS. The fact may be associated with a wide range of risk factors for the development of functional disorders of the body in general and the visual system in particular when the patients is engaged in activities requiring the use of electronic systems in information management.

Comparative study of objective and subjective parameters of accommodation in children with myopia

AIM: The study aims to compare the results of objective parameters such as autorefractometers of the open field Grand Seiko and closed field TONOREF III. and the subjective parameters such as the positive of relative accommodation (PRA) and the amplitude of accommodation (AA).&#x0D; MATERIAL AND METHODS: 30 children (60 eyes) with low and moderate myopia (on average -2.96 0.17 D) aged from 8 to 12 years (on average 10.04 0.24 years) were examined. Subjective (PRA, AA) and objective parameters of binocular adaptation (BAO) and monocular adaptation (MAO) response on the Grand Seiko Binocular Open Field Autorefkeratometer WR - 5500K (Japan) and the AA on the automatic refractokeratotonometer pakhimetre TONOREF III (Nidek, Japan) were determined.&#x0D; RESULTS: The average of BAO and MAO at 33 cm was -1.93 0.04 D and 1.86 0.05 D, respectively. The average PRA was 1.5 0.16 D. The objectively measured average AA was 5.25 0.4 D. The average minimum AA value was -2.86 0.16 D, and the average maximum value was 8.11 0.46 D. The subjective AA on the Iksar device was on average 4.17 0.43 D; Amin, on average -3.77 0.26 D; Amax, on average was -7.94 0.59 D.&#x0D; CONCLUSION: The objective and subjective measurements of AA produced comparable results. BAO and MAO reflected other characteristics of accommodation, different from its amplitude, and characterized the adequacy of the accommodation response to a specific accommodation task. The advantage of objective accommodation is that it is independent of the patients responses and intellectual level.

Accommodation Dynamics in Children Wearing Bifocal Soft Contact Lenses with High Addition Power

Purpose: to evaluate dynamics of subjective and objective accommodation in children wearing bifocal soft contact lenses (BSCLs) for myopia control with +4.00 D addition power. M e t h o d s: the study involved 22 patients (44 eyes).Mean age amounted to 10.1 ± 1.46 years and mean myopic refraction amounted to –3.21 ± 1.23 D. Patients were fitted Prima BIO Bi-focal BSCLs (OKVision Retail, Russia). All patients underwent cycloplegic refraction assessed with Auto Ref/Keratometer ARK 530A (Nidek, Japan), had axial length measured with IOL Master 500 optical biometry device (Carl Zeiss, Germany), had positive relative accommodation (PRA) assessed with and without lenses and had binocular (BAR) and monocular (MAR) accommodative response assessed at a distance of 33 cm with WAM-5500 Binocular Accommodation Auto Ref/Keratometer (Grand Seiko, Japan) prior to wearing BSCLs as well as 3, 6 and 12 months after wearing BSCLs.Results: neither MAR nor BAR measured without lenses changed after 3, 6 and 12 months of wearing BSCLs (p &gt;0,05). A change in PRA evaluated without lenses was noted after 12 months (p &lt; 0,05). PRA evaluated with lenses after 3, 6 and 12 months differed from baseline significantly (p &lt; 0,001). Over 12 months of wearing BSCLs, changes in AL (0.09 ± 0.17 mm) and cycloplegic refraction (0.3 ±0.43 D) correlated with baseline BAR and MAR loosely. C o n c l u s i o n: objective accommodation (MAR and BAR) did not change in the course of wearing BSCLs with +4.00 D addition power. Increase in PRA evaluated without BSCLs may be associated with improvement of accommodation due to a full correction in the optic zone. The gradual increase in PRA evaluated with BSCLs probably indicates an adaptation of patients to addition zone in near vision conditions.

A comparison of accommodation and ocular discomfort change according to display size of smart devices

BackgroundTo evaluate the change of accommodation and ocular discomfort according to the display size, using quantitative measurements of accommodation and ocular discomfort through subjective and objective metrics.MethodsForty six subjects without any ophthalmic disease history were asked to watch the documentary movie, using two different sizes of smart devices; smartphones and tablets. Before and after using devices, the near point accommodation (NPA) and the near point convergence (NPC) were measured, and objective accommodation was measured using an auto refractometer/keratometer. The subjective ocular discomfort was assessed through a survey.ResultsBoth devices showed a decrease in post-use NPA and NPC, and the change after use of the smartphone was significantly severe, 1.8 and 2.5 folds respectively, compared to tablet (p = 0.044, p = 0.033, respectively). Neither smartphone nor tablet showed significant changes in the accommodative response induced by dynamic accommodative stimulus of auto refractometer/keratometer (p = 0.240 and p = 0.199, respectively). Subjects showed a more severe increase in ocular discomfort after using smartphones (p = 0.035) and reported feeling tired even with shorter use times (p = 0.012).ConclusionsBoth devices showed significant decreases in NPA and NPC, and the larger changes were seen when using the small display smartphone. Even within 20minutes of using, subjects start to feel ocular discomfort, and it was more severe and faster after smartphones than tablets. Therefore, the smaller the display size, the greater the adverse impact on eyes, and thus, appropriate display size will need to be selected depending on the time and purpose of use.