0093-7002/87/6406-0430$02.00/0

Vol. 64, No. 6, pp. 430—436

AMERICAN JOURNAL OF OPTOMETRY & PHYSIOLOGICAL OPTICS

Printed in U.S.A.

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 au-

tomated accommodative facility training. A

matched-subjects, crossover design was used

to control for placebo effects. All patients re-

ceiving 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 re-

ported changes by patients. This experiment

shows the effectiveness of automated accom-

modative training in reducing asthenopia and

improving accommodative facility.

Key Words: accommodation, accommodative

infacility, accommodation insufficiency, as-

thenopia, 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 concentra-

tion.1-4 Previous studies have shown that both

prolonged accommodation and repetitive near-

far accommodative demands produce an in-

crease in asthenopia complaints and a decrease

in accommodative amplitude in some pa-

tients.5-8

Traditional treatment of accommodative dys-

functions 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 accommo-

dative amplitude could be improved by specified

training. Liu et al.” have shown with an infrared

recording optometer that accommodative train-

ing results in an improvement in accommodative

amplitude and its time constants. In the above

studies, subjects who reported asthenopia ini-

tially showed a decrease of such symptoms after

training. Morris’2 and Hoffman et al.13 have

suggested that approximately 85% of all accom-

modative anomalies (i.e., accommodative insuf-

ficiency, ill-sustained accommodation, and ac-

commodative inertia) can be treated successfully

with accommodative training; their patients re-

ported fewer asthenopia complaints after train-

ing than before training. Recently, Daum 14,15

published a retrospective study of 96 patients

with accommodative anomalies. He found that

accommodative therapy improved accommoda-

tive amplitudes by at least 3.00 D and resulted

in a concurrent reduction of asthenopic symp-

toms in 88% of the patients, whereas patients

treated only with plus lenses had far fewer re-

ductions in symptoms. Daum 14,15 concluded that

accommodative training was more effective in

relieving asthenopic complaints than plus len-

ses.

Although each of the studies cited above sug-

gests that accommodative training can be used

to improve accommodation and relieve associ-

ated asthenopia, interpretation of the results is

equivocal because of various methodological de-

ficiencies. 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 quanti-

tatively 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 train-

ing upon vergence ranges and asthenopia in

430