The influence of interactions between accommodation and convergence on the lag of accommodation

Several models of myopia predict that growth of axial length is stimulated by blur. Accommodative lag has been suggested as an important source of blur in the development of myopia and this study has modeled how cross-link interactions between accommodation and convergence might interact with uncorrected distance heterophoria and refractive error to influence accommodative lag. Accommodative lag was simulated with two models of interactions between accommodation and convergence (one with and one without adaptable tonic elements). Simulations of both models indicate that both uncorrected hyperopia and esophoria increase the lag of accommodative and uncorrected myopia and exophoria decrease the lag or introduce a lead of accommodation in response to the near (40 cm) stimulus. These effects were increased when gain of either cross-link, accommodative convergence (AC/A) or convergence accommodation (CA/C), was increased within a moderate range of values while the other was fixed at a normal value (clamped condition). These effects were exaggerated when both the AC/A and CA/C ratios were increased (covaried condition) and affects of cross-link gain were negated when an increase of one cross-link (e.g. AC/A) was accompanied by a reduction of the other cross-link (e.g. CA/C) (reciprocal condition). The inclusion of tonic adaptation in the model reduced steady state errors of accommodation for all conditions except when the AC/A ratio was very high (2 MA/D). Combinations of cross-link interactions between accommodation and convergence that resemble either clamped or reciprocal patterns occur naturally in clinical populations. Simulations suggest that these two patterns of abnormal cross-link interactions could affect the progression of myopia differently. Adaptable tonic accommodation and tonic vergence could potentially reduce the progression of myopia by reducing the lag of accommodation.