Near work symptoms and measures of accommodation in children

Abstract

Clinical relevance: Some children experience significant symptoms while doing near work, and accommodative deficits can be a contributory factor. However, studies investigating near work symptoms in children are sparse.

Background: To investigate the association between clinical and objective measures of accommodation and near point symptoms.

Methods: Twelve asymptomatic and 14 symptomatic children (mean age = 11.1 and 11.8 years, respectively) based on their Convergence Insufficiency Symptom Survey scores participated in the study. The clinical measures of accommodation were monocular amplitude of accommodation, monocular accommodative facility, and monocular estimation method. Objective measurements of the accommodative stimulus response function were recorded with a WAM-5500 autorefractor for two consecutive minutes at five viewing distances (0.33, 2, 3, 4, and 5 Dioptres [D]). Accommodative findings were compared between the groups using the Mann-Whitney U-tests. Spearman's rank correlation coefficient was used to assess the association between symptoms and clinical and objective measures of accommodation.

Results: The mean CISS scores were 32.8 and 7.3 for the symptomatic and asymptomatic groups, respectively (p = <0.001). The symptomatic group showed a reduced accommodative functions compared to the asymptomatic group (p = 0.002 for accommodative facility, p = 0.04 for accommodative amplitude, p = 0.029 and 0.01 for objective measures of accommodation at 4D and 5D viewing distance, respectively). Clinical tests of accommodative amplitude and facility (correlation coefficient = -0.407 and -0.54, respectively) showed the highest correlation with the CISS scores, compared to the objective measures of accommodation.

Conclusion: Clinical tests of accommodation showed a greater association with symptoms than objective measures of accommodation in children aged 8-16 years. In children presenting with visual discomfort symptoms, measurement of accommodative amplitude and facility should be considered.

Keywords: Accommodation; objective measures; symptoms.