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The accommodative process in children with cerebral palsy: different strategies to obtain clear vision at short
Tony Pansell1, Kerstin Hellgren, Lena Jacobson
1Department of Clinical Neuroscience, Ophthalmology and Vision, St Erik Eye Hospital, Karolinska Institutet, Stockholm, Sweden.
Insights
Children with cerebral palsy (CP) show significantly impaired accommodation, leading to focusing errors that may impact daily activities and reading. This study highlights the need for better assessment techniques for visual function in children with CP.
Area of Science:
- Ophthalmology
- Pediatric Vision
- Neuroscience
Background:
- Accommodation is crucial for clear vision at varying distances.
- The accommodative process in children, especially those with neurological conditions, is not well understood.
- New methods are needed to assess visual function in children with cerebral palsy (CP).
Purpose of the Study:
- To investigate the accommodative process in children with and without CP.
- To compare the accommodation response between typically developing children and children with CP.
- To identify potential visual challenges faced by children with CP.
Main Methods:
- A descriptive case-control study comparing children with CP (n=15) and typically developing children (n=21).
- Standard ophthalmological examination and PowerRefractor assessment measuring accommodation to minus lens stimuli.
- Statistical analysis included Kruskal-Wallis ANOVA and Mann-Whitney U test for between-group comparisons.
Main Results:
- Typically developing children had an accommodative gain of ~80% with a small focusing error (0.2-0.5D).
- Children with CP demonstrated significantly reduced accommodation (gain: ~30%, p<0.001) and larger focusing errors (1.1-1.7D).
- Accommodative responses were slower and more variable in children with CP; pupil responses did not correlate with accommodation.
Conclusions:
- Children with CP exhibit significant deficits in their accommodative response.
- These accommodative problems can negatively affect daily visual tasks, including reading.
- Further research and targeted interventions are warranted for visual rehabilitation in children with CP.
Aim:
Accommodation is the ability of the eye to change focus in order to maintain a sharp image of objects at various distances. The accommodative process is largely unknown in children and requires new assessment techniques. The aim of the study was to investigate this process in children with and without cerebral palsy (CP).
Method:
In a descriptive case-control study, children with CP (n=15; nine females, six males; median age 14y) and 21 typically developing children (11 females, 10 males; median age 12y) underwent standard ophthalmological examination and examination by the PowerRefractor. Six of the children had spastic bilateral CP, five had spastic unilateral CP, and four had dyskinetic CP. The children's Gross Motor Function Classification System (GMFCS) levels were as follows: level I, seven children; level II, two children; level III, three children; and level IV, three children. The PowerRefractor measures accommodation in response to minus lens stimuli. Continuous measurements of refraction/accommodation, eye position, and pupil size are obtained. The Kruskal-Wallis analysis of variance (ANOVA) and Mann-Whitney U test were used for between-group analysis (α=0.05), and Friedman ANOVA was used for within-group analysis.
Results:
The stimuli-response gain (input/output) was approximately 80% in typical children inducing a focusing error (0.2-0.5D) increasing with minus lens power. Children with CP accommodated significantly less (gain: ~30%; p<0.001), inducing a larger focusing error (1.1-1.7D) increasing with minus lens power. The accommodative response was slower and more variable in children with CP. The pupil response did not mirror the accommodative response.
Interpretation:
Children with CP exhibit problems in generating an appropriate accommodative response. This can affect everyday living and reading skills.
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