Clues for the Diagnosis of Accommodative Excess and Its Treatment with a Vision Therapy Protocol
Carmelo Baños
Departamento de Física Teórica, Atómica y Óptica, Universidad de Valladolid, Valladolid, Spain. and General Optica, Burgos, Spain.
Eneko Zabalo
Bidasoa Optika, Ikusgune Centro de optometría, Donostia-San Sebastián, Spain.
Irene Sánchez *
Departamento de Física Teórica, Atómica y Óptica, Universidad de Valladolid, Valladolid, Spain. and Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain. and Optometry Research Group, IOBA Eye Institute, School of Optometry, University of Valladolid, 47011, Valladolid, Spain.
*Author to whom correspondence should be addressed.
Abstract
Introduction: Accommodative and vergence dysfunctions are the most common vision disorders in the pediatric population with a prevalence of up to 30%, and patients with these dysfunctions usually have symptoms at near distances that could affect academic results. This study is the retrospective assessment of accommodative excess cases and aims to find a pattern in optometric exams to help diagnose accommodative excess without cycloplegic drugs. Furthermore, this study assesses the utility of a vision therapy protocol as accommodative excess treatment.
Methodology: A retrospective study was conducted with 24 patients who were diagnosed with accommodative excess and completed all sessions of the vision therapy protocol. The vision therapy protocol was organized into 8-12 sessions. Statistical analysis was performed using SPSS 23.0. Wilcoxon nonparametric paired tests were used to compare the clinical values between visits.
Results: In total, 24 patients with accommodative excess were included in the retrospective study. The pairwise comparisons of sphere values obtained with the different refraction methods without cycloplegic drugs found statistically significant differences (P< 0.01). Statistically significant differences (P< 0.01) were shown in the sphere values obtained from subjective refraction, visual acuity tests, near point of convergence and stereopsis between the diagnosis visit and the post-vision therapy protocol visit, with better values post-therapy.
Conclusion: Variations in the sphere values could be clues for accommodative excess if a double condition is given, the retinoscopy results are more positive than the subjective refraction findings (>0.60D) and are more positive than the values obtained with an auto refractor (>1.75D).
Keywords: Accommodative excess, vision therapy, pseudomyopia, spasm of the near reflex, accommodative spasm.