Spasm of near reflex: a comprehensive management protocol and treatment outcomes

To report a consolidated management protocol for patients with spasm of near reflex (SNR), including classification of cases as mild, moderate, and severe based on treatment outcomes.

Patients with SNR treated at a single institution between August 2016 and November 2018 were included. Management of SNR included modified optical fogging, vision therapy, and pharmacological intervention (cyclopentolate eye drops and, if required, atropine eye drops). Outcome measures were visual acuity (20/25 or better) and refractive error (reduction of excessive myopia).

Of 1,306 patients examined during the study period, 66 were diagnosed with SNR, yielding a prevalence of 5% among first-time patients visiting our binocular vision and orthoptics clinic. Of the 45 patients recruited for this study (mean age, 14 ± 5 years; 24 males), all three near-triad components were involved in 11 patients (24%), only the accommodation component in 32 (71%), and only the convergence component in 2 (4%). SNR was relieved in the first post-cyclopentolate refraction visit or with the modified optical fogging technique in 29 patients (66%; mild SNR) and with one-time usage of atropine eyedrops in 10 patients (22%; moderate SNR). In 6 patients (13%), atropine was continued long-term (severe SNR). Of 15 patients with long-term follow-up (1 year), 11 (73%) had persistent relief of SNR.

In our study cohort, SNR with accommodation component was the most common and could be largely relaxed through a one-time use of cycloplegic eye drops and optical intervention. Only severe forms of SNR may require extended use of strong cycloplegics.