Clinical approaches to nearpoint lens power determination

Qualitative and quantitative criteria for prescribing plus lenses at near for prepresbyopes together with 12 behavioral objectives are described. Four quantitative prescription criteria are presented using a combined monocular estimate method-low neutral (MEM-LN) dynamic retinoscopy testing procedure. Each of the four prescription criteria are evaluated relative to an arbitrary +0.50 sphere prescription for seven different observable patterns of accommodative responses at 40 cm. Clinical and research implications of prescribing plus spheres are evaluated relative to the change in proximal stimulus characteristics and the change in accommodative response. Intersystem and intermodal consequences are suggested.