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Accommodative lag and refractive error in infants and toddlers
1Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. ktarczyhornoch@chla.usc.edu
Insights
Most young children accommodate well, but significant hyperopia (≥4.0 D) is linked to poor accommodative performance. Different astigmatism types show varied accommodation patterns in children.
Area of Science:
- Pediatric Ophthalmology
- Visual Development
- Refractive Error
Background:
- Assessing accommodative function is crucial for understanding visual development in infants and young children.
- Refractive errors, including hyperopia and astigmatism, are common in early childhood and can impact visual outcomes.
Purpose of the Study:
- To investigate the relationship between refractive error and accommodative performance in children aged 5 to 24 months.
- To determine how different types and degrees of refractive error influence the accommodative response in this age group.
Main Methods:
- Prospective study involving 189 typically developing children aged 5-24 months.
- Accommodation lag measured using modified bell retinoscopy.
- Refraction assessed via cycloplegic retinoscopy, averaging results from both eyes.
Main Results:
- Accommodation lag and reduced accommodative response gain were more prevalent in younger children.
- Most children (95%) exhibited lags <1.25 D, indicating generally good accommodation.
- Significant hyperopia (≥4.0 D) was associated with a majority of children having lags ≥1.25 D.
- Hyperopic astigmatism showed increased lag in the hyperopic meridian, unlike myopic or mixed astigmatism.
Conclusions:
- The majority of young children accommodate adequately even with moderate hyperopia.
- Hyperopia of 4.0 D or greater is rarely associated with normal accommodative function.
- Distinct accommodative patterns in relation to astigmatism types may explain observed visual acuity deficits.
Purpose:
To measure accommodative performance as a function of refractive error in very young children.
Methods:
This was a prospective study of accommodation lag in multiethnic typically developing children ages 5 to 24 months. Accommodation lag was measured by means of a modified bell retinoscopy technique. Refraction was measured by cycloplegic retinoscopy, and right and left eye results were averaged. The study compared accommodative performance to cycloplegic spherical equivalent and astigmatic refractive error.
Results:
Analysis of data from 189 of 203 subjects revealed that larger lags and lower gain of the accommodative response were more common in younger children, although most children of all ages accommodated well, with 95% having lags <1.25 D. Larger accommodation lags were associated with greater spherical equivalent refractive error, although only with hyperopia ≥4.0 D were lags ≥1.25 D observed in a majority of children. Larger lags in the more hyperopic meridian were seen with increasing hyperopic with-the-rule astigmatism, but lag in the more hyperopic meridian varied little with the amount of myopic or mixed astigmatism.
Conclusions:
Most 5- to 24-month-old children accommodate well over a range of moderate hyperopic refractive errors, but hyperopia ≥4.0 D is rarely associated with normal accommodative performance. Hyperopic and mixed or myopic astigmatic children show different patterns of accommodation, which may explain the patterns of visual acuity deficits seen in these children.
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