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Does the dynamic cross cylinder test measure the accommodative response accurately?

Jaclyn A Benzoni1, Juanita D Collier, Kimberley McHugh

  • 1State University of New York State College of Optometry, New York, New York 10036, USA.

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Summary

The subjective Dynamic Cross Cylinder (DCC) test inaccurately measures accommodative response (AR) in young adults compared to objective methods. Alternative objective techniques are recommended for precise AR assessment.

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Area of Science:

  • Ophthalmology
  • Optometry
  • Vision Science

Background:

  • The Dynamic Cross Cylinder (DCC) test is a subjective clinical method for assessing accommodative response (AR).
  • Ambiguous stimulus conditions in the DCC test raise questions about its accuracy in measuring AR.
  • This study aimed to validate subjective DCC findings against objective AR measurements.

Purpose of the Study:

  • To compare subjective accommodative response (AR) measurements using the Dynamic Cross Cylinder (DCC) test with objective measurements.
  • To evaluate the accuracy of the DCC test in young subjects.
  • To determine if objective optometry can provide a more reliable AR assessment.

Main Methods:

  • Compared subjective DCC test findings (without fogging) to objective AR measurements using a Grand Seiko WAM 5500 optometer.
  • Tested 25 young subjects with a 2.50-diopter accommodative stimulus.
  • Recorded objective AR measurements through spherical lenses introduced to quantify subjective findings.

Main Results:

  • Mean subjective AR was 2.35 D, while mean objective AR was 1.68 D (P < 0.0001).
  • Subjective assessment showed 10 subjects with accommodative lead, but only 1 had an objective lead.
  • All 8 subjects with subjective accommodative lag also demonstrated objective lag; lens introduction significantly altered mean AR.

Conclusions:

  • The subjective Dynamic Cross Cylinder (DCC) test is not an accurate method for measuring accommodative response (AR) in young individuals.
  • Objective optometry, such as open-field optometers or Cross-Nott retinoscopy, is recommended for accurate within-task AR determination.
  • Clinical practice should consider adopting objective techniques for more reliable AR assessments.