Comparison of clinical techniques to assess the near accommodative response

Assessment of the accommodative response (AR) is an essential part of the optometric examination. This study compared a number of clinical procedures for determining the AR with the findings of an objective infrared autorefractor. First, the AR to a 2.5 D binocular stimulus was measured by dynamic retinoscopy (neutralization being obtained both with lenses and by varying the working distance), dynamic cross-cylinder (with and without fogging lenses), and a near red-green duochrome test. Second, the response to a monocular 2.5 D stimulus was examined using dynamic retinoscopy (neutralizing with lenses), dynamic cross-cylinder, and the red-green duochrome. Third, the monocular AR was examined with both red-green and blue-yellow near duochrome tests. Under binocular conditions, the mean ARs for all the tests were clinically equivalent. However, comparison with the findings from the objective autorefractor indicated that dynamic retinoscopy (where neutralization was obtained by varying the working distance) showed the closest agreement, whereas the two dynamic cross-cylinder procedures exhibited the greatest variability. For the monocular condition, the mean lag of accommodation observed with the autorefractor was significantly less than that observed with dynamic retinoscopy, the dynamic cross-cylinder, or the red-green duochrome. However, the blue-yellow near duochrome test did not provide a valid estimation of the AR. It is concluded that the technique of dynamic retinoscopy where the working distance is varied to obtain a neutral reflex should be the method of choice for the clinical assessment of the AR, because this procedure does not require the introduction of supplementary lenses, which may themselves alter the AR.