Study on accommodation by autorefraction and dynamic refraction in children

Childhood accommodation interferes with accurate diagnosis of the latent refractive errors. Dynamic retinoscopy offers accurate measurements of accommodative response, while an autorefractometer can predict the accommodative system activation in children. A correlation of the accommodative effort with the dynamic refraction has been investigated in emmetropic children, before and after cycloplegia.

A prospective clinical study of accommodative effort in 149 emmetropic children, in the age group 3-16 years, has been conducted using TOPCON AR RM-8000B autorefractor. Dynamic refraction was performed by monocular estimation method before and after cycloplegia, using the retinoscope mirror light as target. Retinoscopic reflex produced 'with the motion' was corrected with positive spherical lenses, and that 'against the motion' was corrected with negative spherical lenses, to achieve neutralization.

Mean accommodative effort measured for 149 children included in the study was -0.63±0.69D and dynamic refraction was -0.07±0.44D before cycloplegia, while the mean was+0.52D after cycloplegia, irrespective of the method used. Autorefractor measured -0.17D of accommodative effort per unit change in dynamic refraction before cycloplegia and +0.90D after cycloplegia.

The performance of TOPCON AR RM-8000B autorefractor was comparable to dynamic retinoscopy. Presence of many children, and in turn, large number of accommodative response data in 11-13 and 14-15 years group is probably linked to prolonged reading/writing. The accuracy and the agreement of the actual accommodative measurements revealed after cycloplegia.