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Diagnostic Validity of Accommodative Tests for Screening Suspected Accommodative Excess in Adolescents
Esther Mármol-Errasti1,2, José Miguel Cárdenas-Rebollo3, Antonio Rodán3,4
1Facultad de Farmacia, Universidad San Pablo-CEU, CEU Universities, Boadilla del Monte, Spain. emarmol@ceu.es.
Summary
Binocular accommodative facility (BAF) and fused cross cylinder (FCC) tests are most effective for detecting accommodative excess (AE) in adolescents. Other tests like MEM retinoscopy and NRA may miss cases, requiring cautious interpretation alongside symptoms.
Area of Science:
- Ophthalmology
- Optometry
- Vision Science
Background:
- Accommodative excess (AE) involves excessive accommodation and difficulty relaxing it, causing eye strain and discomfort during near work.
- Current diagnostic criteria for AE are inconsistent, and the effectiveness of common clinical tests is not well-established.
Purpose of the Study:
- To evaluate the diagnostic accuracy of tests measuring accommodative response and relaxation for detecting suspected AE in adolescents.
- To compare the performance of various accommodative tests against monocular accommodative facility (MAF) as the reference standard.
Main Methods:
- A prospective observational study involving 142 adolescents (aged 13-14) with comprehensive vision examinations.
- Measurements included negative relative accommodation (NRA), fused cross cylinder (FCC), binocular accommodative facility (BAF), and monocular estimate method (MEM) retinoscopy.
- Diagnostic validity was assessed using ROC curves, sensitivity, specificity, and likelihood ratios, with MAF as the reference.
Main Results:
- Binocular accommodative facility (BAF) demonstrated the highest diagnostic accuracy (AUC=0.97) with excellent sensitivity (0.88) and specificity (0.97).
- Fused cross cylinder (FCC) also showed strong performance (AUC=0.79), with high sensitivity (0.90) and good specificity (0.79).
- Monocular estimate method (MEM) retinoscopy and NRA had lower sensitivity (0.22 and 0.32, respectively), despite high specificity.
Conclusions:
- BAF and FCC are the most sensitive tests for identifying suspected AE in school-aged populations.
- MEM retinoscopy and NRA show limited sensitivity and may not detect AE, necessitating cautious interpretation and use alongside other tests and symptoms.
