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Published on: March 3, 2023
948
Objective and subjective assessment of accommodative insufficiency.
Alejandro León1, Mark Rosenfield, Sandra Milena Medrano1
1Facultad de Ciencias de la Salud, Universidad de la Salle, Bogotá, Colombia.
Summary
Diagnosing accommodative insufficiency requires a method-specific approach, as subjective and objective measures are not interchangeable. Hofstetter's criterion needs re-evaluation for accurate diagnosis across different techniques.
Area of Science:
- Ophthalmology
- Optometry
- Vision Science
Background:
- Accurate diagnosis of accommodative insufficiency is crucial for visual function.
- Various subjective and objective methods exist to measure amplitude of accommodation.
- The applicability of Hofstetter's criterion across these methods is not well-established.
Purpose of the Study:
- To examine the use of objective dynamic retinoscopy and three subjective techniques for diagnosing accommodative insufficiency.
- To evaluate the diagnostic validity of dynamic retinoscopy compared to traditional criteria.
Main Methods:
- 632 subjects (8-19 years) underwent assessment of accommodative lag, monocular accommodative facility, and amplitude of accommodation (subjective: push-up, modified push-down, minus lens; objective: dynamic retinoscopy).
- Accommodative insufficiency diagnosed using Hofstetter's minimum minus 2 D criterion, with and without additional subjective criteria (lag > 0.75 D or facility < norms).
Main Results:
- Prevalence of accommodative insufficiency varied significantly by method, from 1% (push-up with added criteria) to 94% (dynamic retinoscopy without added criteria).
- Dynamic retinoscopy showed moderate to low sensitivity and high specificity against traditional criteria, improving with added subjective criteria.
- A dynamic retinoscopy cutoff of 7.50 D demonstrated moderate diagnostic accuracy.
Conclusions:
- A revised definition of accommodative insufficiency is needed, incorporating the specific assessment method.
- Objective and subjective methods for measuring accommodation amplitude are not interchangeable.
- Subjective assessment alone may not reliably measure the accommodative response.
