Copyright © 1987 AMERICAN ACADEMY OF OPTOMETRY

Reduction of Asthenopia after Accommodative Facility Training

JEFFREY COOPER,* JERRY FELDMAN,t ARKADY SELENOW,t RON FAIR,t

FRANK BUCCERIO,t DAVID MacDONALD,f and MICHELLE LEVY~

Schnurmacher Institute for Vision Research, State College of Optometry, State University of New York, New York

ABSTRACT

Five patients reporting asthenopia secondary to accommodative deficiencies underwent automated accommodative facility training. A matched-subjects, crossover design was used to control for placebo effects. All patients receiving automated accommodative training showed a marked increase in accommodative amplitude along with a concurrent reduction of asthenopia. Decreases of blur and increases of reading time were the most frequently reported changes by patients. This experiment shows the effectiveness of automated accommodative training in reducing asthenopia and improving accommodative facility.

Key Words: accommodation, accommodative infacility, accommodation insufficiency, asthenopia, blur, orthoptics, vision training

Accommodative insufficiency, ill-sustained accommodation, and accommodative inertia (accommodative infacility) are found in some nonpresbyopic patients. These conditions are often associated with blurred vision, asthenopia, reduced reading time, and loss of concentration.1-4 Previous studies have shown that both prolonged accommodation and repetitive near- far accommodative demands produce an increase in asthenopia complaints and a decrease in accommodative amplitude in some pa tients.5-8

Traditional treatment of accommodative dysfunctions often involves orthoptic techniques.

Presented at the Annual Meeting of the American Academy of Optometry, Atlanta, Georgia, December, 1985.

Received August 12, 1986; revision received Decem ber 10, 1986.

* Optometrist, M.Sc., Member of Faculty, F.A.A.O.

t Psychologist, Ph.D., Member of Faculty.

Optometrist, Member of Faculty.

Mare and Cornsweet and Crane10 demonstrated that voluntary accommodation and accommodative amplitude could be improved by specified training. Liu et al.” have shown with an infrared recording optometer that accommodative training results in an improvement in accommodative amplitude and its time constants. In the above studies, subjects who reported asthenopia initially showed a decrease of such symptoms after training. Morris’2 and Hoffman et al.13 have suggested that approximately 85% of all accommodative anomalies (i.e., accommodative insufficiency, ill-sustained accommodation, and accommodative inertia) can be treated successfully with accommodative training; their patients reported fewer asthenopia complaints after training than before training. Recently, Daum 14,15 published a retrospective study of 96 patients with accommodative anomalies. He found that accommodative therapy improved accommodative amplitudes by at least 3.00 D and resulted in a concurrent reduction of asthenopic symptoms in 88% of the patients, whereas patients treated only with plus lenses had far fewer reductions in symptoms. Daum 14,15 concluded that accommodative training was more effective in relieving asthenopic complaints than plus lenses.

Although each of the studies cited above suggests that accommodative training can be used to improve accommodation and relieve associated asthenopia, interpretation of the results is equivocal because of various methodological deficiencies. For example, most studies failed to control for experimenter bias or placebo effects, used other concurrent treatments, or included other sources of experimental confounding. None have attempted to measure changes in asthenopia severity systematically and quantitatively by a written rating questionnaire. An earlier study by Cooper et al. did address both these issues.’6 In that study, a matched-subjects, crossover experimental design was used to assess the effect of automated fusional vergence training upon vergence ranges and asthenopia in

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