the short period of 6 weeks. Typically standard accommodative therapy is practiced at home 5 days a week and continued for at least 2 months. Most patients treated that way rarely return to the office reporting the same symptoms; treatment effects appear long-lasting.

It was difficult to find patients for this study because of our requirement that they have three reduced accommodative findings without an associated vergence anomaly. Over 90% of the patients we tested in our clinic who had a primary accommodative anomaly also had an associated vergence anomaly, and thus did not meet the inclusion criteria for our study. Cooper et al.16 have also found it difficult to identify convergence insufficiencies without an accommodative component, unless the patients were presbyopic. Most patients with ocularly related asthenopia have a combined accommodativevergence anomaly, indicating the need for both accommodative and vergence training.

The present study did not find any improvement in stereopsis or vergence after accommodative therapy, contrary to studies by Daum.14,15 Tentatively, our findings can be interpreted as indicating that specific monocular accommodative therapy does not transfer to these binocular abilities. It is possible to account for some of the difference between our findings and those of Daum by our use of a control group, which lessens the potential for experimenter bias and placebo effects.

In summary, earlier studies have pointed to accommodative anomalies as a source of asthenopia. Some reports7’8 have indicated that most patients receiving repeated accommodative stimulation do not develop asthenopia. However, these investigators state that those patients who do develop asthenopia during repeated accommodative stimulation also develop accommodative fatigue. Other uncontrolled or retrospective studies13-15 have shown that patients with accommodative related asthenopia respond to accommodative therapy if training is progressive and gradual. The present study supports these findings and we believe also demonstrates that our results are not due to experimental bias, placebo, or order effects. Rather, the reduction in asthenopic symptoms, particularly with regard to blur and reading time, appears to be a direct function of improvements in amplitude, speed, and sustaining time of accommodation.

APPENDIX A

Asthenopia Questionnaire

1. How long can you do nearwork (i.e., reading, writing, sewing, etc.) without discomfort (e.g.,

headaches, eye ache, burning, stinging, watering, blurriness, double vision, loss of concentration, or tiredness)?

1 up to 15 min

2 up to 20 min

3 up to 1 h

4 up to 2 h

5 at least 3 h

or do you get headaches, or does the print blur or run together after doing nearwork?

1 every time that I read

(100% of the time)

2 very often

(about 75% of the time)

3 often

(about 50% of the time)

4 occasionally

(about 25% of the time)

5 never

(0% of the time)

objects at distance appear blurry?

1 every time that I read

(100% of the time)

2 very often

(about 75% of the time)

3 often

(about 50% of the time)

4 occasionally

(about 25% of the time)

5 never

(0% of the time)

you have when you do nearwork. Answer on other side of paper.

REFERENCES

cases. Am J Optom Physiol Opt 1942;19:279—89.

Refraction. In: Duke-EIder S, ed. System of Ophthalmology, vol 5. St Louis: CV Mosby, 1970:451—

86.

considered. Arch Ophthalmol (Old Series) 191 6;45:1 24—36.

JF, ed. Diagnosis and Management in Vision Care. Boston: Butterworths, in press.

dation as registered by the ergograph. Trans Am Ophthalmol Soc 1917;15:145—53.

Fatigue of accommodation: experimental and dinical observations. Am J Ophthalmol 1932;15:527—

42.

of accommodation: plan of research and observations on recession of near point of accommodation following a period of interpolated work on the ophthalmic ergograph. Arch Ophthalmol 1944;