Insufficient accommodation during binocular near viewing in eyes with intermittent exotropia

To investigate the changes in spherical equivalent and pupil response during near viewing in patients with intermittent exotropia (IXT) who have complaints of blurred vision or asthenopia from near viewing in daily life using a novel binocular wavefront aberrometer.

A cross-sectional study.

Ten IXT patients and ten healthy subjects wearing full-correction lenses at far sight (5 m) were instructed to fixate on a near target at 67 cm, which was then moved to 40 cm three times. Serial changes in the spherical equivalent (SE) refractive error (SE) were measured during this task using a laboratory-made open-field binocular Hartmann-Shack wavefront aberrometer and compared between patients and healthy subjects. In the IXT patients, regression analysis was performed between ∆SE and exodeviation angles, as measured by an alternate prism and cover test. Pupil-diameter and pupil-constriction ratios were also compared between patients and healthy subjects, and the correlation of constriction ratio with ∆SE was calculated for both groups.

Compared to healthy subjects, IXT patients demonstrated significantly lower ∆SE of convergence (mean ± SD, 0.91 ± 0.26 D vs. 1.15 ± 0.19 D; P < 0.05) and divergence (0.93 ± 0.28 D vs. 1.16 ± 0.20 D; P < 0.05). Angle of exotropia was negatively correlated with ∆SE during far-sight and near-sight convergence and divergence (P < 0.05). Pupil-constriction ratio was also reduced in patients compared to healthy subjects (6.67% ± 3.31% vs. 11.9% ± 5.96%; P<0.05). Pupil-constriction ratio was positively correlated with ∆SE during convergence in both groups (P < 0.05).

Insufficient accommodation and pupil constriction during near viewing were observed in patients with IXT who had complaints of blurred vision or asthenopia from near viewing. These conditions might contribute to symptoms, such as fatigue, eye strain and impaired visual performance.