The magnitude and distribution of open-loop accommodation using three different methods of opening the loop

Accommodative anomalies in children

Asthenopic and related symptoms are a major problem in school-going children. With the inception of computers and other gadgets for near work, the unseen problems arising out of constant and continuous near work, are on the rise. Parents wander from pillar to post, seeking respite from their child's constant complaints from near work; but despite best spectacle correction and avoidance of excessive near work, the complaints continue. Studies have shown that the majority of these problems arise from defects in accommodation, even in a young child. Therefore, various aspects of accommodation deficiencies have to be studied clinically, detected, and treated to ameliorate the symptoms.

Tonic accommodation predicts closed-loop accommodation responses

The purpose of this study is to examine the potential relationship between tonic accommodation (TA), near work induced TA-adaptation and the steady state closed-loop accommodation response (AR). Forty-two graduate students participated in the study. Various aspects of their accommodation system were objectively measured using an open-field infrared auto-refractor (Grand Seiko WAM-5500). Tonic accommodation was assessed in a completely dark environment. The association between TA and closed-loop AR was assessed using linear regression correlations and t-test comparisons. Initial mean baseline TA was 1.84diopter (D) (SD±1.29D) with a wide distribution range (-0.43D to 5.14D). For monocular visual tasks, baseline TA was significantly correlated with the closed-loop AR. The slope of the best fit line indicated that closed-loop AR varied by approximately 0.3D for every 1D change in TA. This ratio was consistent across a variety of viewing distances and different near work tasks, including both static targets and continuous reading. Binocular reading conditions weakened the correlation between baseline TA and AR, although results remained statistically significant. The 10min near reading task with a 3D demand did not reveal significant near work induced TA-adaptation for either monocular or binocular conditions. Consistently, the TA-adaptation did not show any correlation with AR during reading. This study found a strong association between open-loop TA and closed-loop AR across a variety of viewing distances and different near work tasks. Difference between the correlations under monocular and binocular reading condition suggests a potential role for vergence compensation during binocular closed-loop AR.

The effect of modulating ocular depth of focus upon accommodation microfluctuations in myopic and emmetropic subjects

The magnitude of accommodation microfluctuations increases in emmetropic subjects viewing low luminance targets or viewing a target through small artificial pupils. Larger microfluctuations reported in myopia may result from an abnormally large depth of focus (DoF). The effect of modulating the size of the DoF has not been investigated in myopic subjects and may help to explain the cause of the increased DoF. Accommodation microfluctuations were recorded under two experimental conditions. Firstly, 12 emmetropes (EMMs), and 24 myopes (MYOs) viewed a Maltese Cross target with luminance levels of 0.002, 0.2, 6 and 600cd/m(2) and in darkness, and second, 14 EMMs and 16 MYOs viewed a Maltese Cross target through pupil diameters of 0.5, 1, 2, 3, 4 and 5mm presented in Maxwellian view. The magnitude of the accommodation microfluctuations increased significantly with a target luminance of 0.002cd/m(2) (p<.03) and pinhole diameters of <2mm (p<.05). For all other luminance levels and pupil diameters the magnitude was constant. For both conditions, MYOs had significantly larger microfluctuations than EMMs (p<.01). Considerable inter-subject variability was observed in the degree to which the magnitude of the microfluctuations increased, for both the 0.002cd/m(2) luminance and 0.5mm pupils, however, this was not correlated with refractive error. The increase in the magnitude of the microfluctuations while viewing a low luminance target (0.002cd/m(2)) may be due to a shallower contrast gradient in the cortical image, with a consequent increase in DoF. The microfluctuations also increase when viewing through small pupils (<2mm), which increases the DoF without altering the contrast gradient. The larger microfluctuations found in the MYOs consolidates the theory that MYOs have a larger DoF than EMMs and therefore have a higher threshold for retinal image blur.

Visual acuity in 5-7-year-old children: individual variability and dependence on observation distance

Accurate measurements of uncorrected binocular and monocular visual acuity were performed in 65 children aged 5-7 years at five viewing distances in the range 0.5-5.0 m by means of the test charts containing widely spaced E stimuli in four orientations. It was found that, in most children of this age, visual acuity (V) changed with test distance, as had been reported previously with older subjects. Visual acuity could be considered as practically independent of observation distance (Vmax-Vmin<or=0.2 decimal units) in <50% of children. The remaining children demonstrated evident distance dependence of visual acuity but the shape of the acuity-distance curve varied. The acuity-distance curve of most children peaked at an intermediate distance (1-2 m), the typical difference Vmax-Vmin being 0.4 decimal units. To explain the existence of an optimal observation distance in the majority of children, a number of developmental and environmental factors could be proposed that adjust the parameters of the visual system to the parameters of operational visual space and prevailing activity.

The autonomic control of accommodation and implications for human myopia development: a review

Prolonged nearwork has long been associated with myopia development, however, there is no well described linking mechanism. One theory suggests that if accommodation accuracy during nearwork is not maintained, the defocused retinal image leads to myopia development. Here we review the findings of research aimed at determining whether the autonomic inputs to the ciliary smooth muscle are involved in this type of environmental myopia. We examine whether an autonomic imbalance could be a precursor to axial elongation and the resulting myopia. Accommodation responses, such as tonic accommodation and nearwork-induced accommodative adaptation, as a function of refractive error, are described in relation to an autonomic imbalance model. The collective results of this research point to anomalous accommodation responses, possibly as a result of underlying anomalous autonomic input to the ciliary muscle, being involved in myopia development and progression.