Accommodative spasm and its different treatment approaches: A systematic review.

Area of Science:

• Ophthalmology and Optometry
• Neuroscience

Background:

• Accommodative spasm involves involuntary ciliary muscle contraction, leading to near vision dysfunction.
• Weaknesses in the near vision triad (accommodation, convergence, miosis) can precipitate accommodative spasm.
• Common triggers include excessive close work, emotional distress, head trauma, and strabismus.

Approach:

• A comprehensive literature search was performed using PubMed and Google Scholar databases, including case reports, cohort studies, and review articles published before June 2022.
• The review synthesized data from twenty-eight case reports, six cohort studies, four book references, four review articles, and two comparative studies.
• Inclusion and exclusion criteria were applied to refine the selection of relevant studies on accommodative spasm and related conditions.

Key Points:

• Variable retinoscopic reflex, unstable refractive error, and accommodative lead are key diagnostic indicators.
• Cycloplegic drops are effective for diagnosis despite potential side effects.
• The modified optical fogging technique shows promise as a treatment option.

Conclusions:

• Accommodative spasm necessitates a multifaceted clinical approach.
• The modified optical fogging method and vision therapy are proposed as comprehensive management strategies to combat the rising incidence of accommodative spasm.
• Other management options include bifocals, manifest refraction, and base-in prisms.