May 2004
Volume 45, Issue 13
Free
ARVO Annual Meeting Abstract  |   May 2004
Spectacle intervention in children with cerebral palsy (CP) and accommodative dysfunction.
Author Affiliations & Notes
  • K.J. Saunders
    School of Biomedical Sciences, University of Ulster, Coleraine, United Kingdom
  • J.F. McClelland
    School of Biomedical Sciences, University of Ulster, Coleraine, United Kingdom
  • Footnotes
    Commercial Relationships  K.J. Saunders, None; J.F. McClelland, None.
  • Footnotes
    Support  College of Optometrists Research Scholarship to JFM
Investigative Ophthalmology & Visual Science May 2004, Vol.45, 1394. doi:
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      K.J. Saunders, J.F. McClelland; Spectacle intervention in children with cerebral palsy (CP) and accommodative dysfunction. . Invest. Ophthalmol. Vis. Sci. 2004;45(13):1394.

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Abstract

Abstract: : Purpose: To examine the utility of spectacle correction (Rx) for children with cerebral palsy (CP) and accommodative dysfunction. Subjects: Subjects were participants in a larger study of visual status amongst children with CP (aged 4–15 years). All received a full visual assessment including measurement of visual acuity (distance and near), refractive error and accommodative function using dynamic retinoscopy. Accommodative responses were assessed at three different distances (10cm [10D], 16.7cm [6D], 25cm[4D]) with distance correction in place. Those children whose accommodative responses were reduced (at more than one distance) compared with age–matched norms were classified as having an accommodative deficit (36/88=40.9%) and entered into the present study. Methods: To examine the impact of spectacle correction in cases of reduced accommodation subjects were entered into one of the following groups; (i) distance Rx given (significant distance Rx previously uncorrected) n=10 (ii) near Rx given (no significant distance Rx or previously fully corrected for distance) n=6 (iii) no near Rx given n=20. Many subjects were deemed unsuitable for near spectacle wear for reasons including myopia (n=10), physical limitations (n=3), severely reduced vision (n=4) and parental refusal (n=3). Accommodation and near visual acuity were re–assessed after 6–12 months. Results: Distance prescriptions were issued to 10 subjects. Of these only 3 subjects had obtained and were wearing the new prescription on retest. The majority of accommodation and near visual acuity measures were unchanged on re–test. One subject demonstrated a significant improvement in accommodative facility during the 12 month retest period. The remainder did not. Near vision prescriptions were given to 6 subjects. Of these 5 used their correction and all demonstrated a significant improvement in accommodative function with their near Rx (over and above that provided by the near addition). Near visual acuity was also improved. Feedback from parents, teachers, carers and subjects highlighted a positive response to near vision spectacles and a perceived improvement in visual acuity and attention. Conclusions: Correction of distance refractive error did not significantly impact on accommodative facility. Provision of near vision correction resulted in an improvement in accommodative facility. In this small sample of children clearer near vision appears to stimulate improved accommodative facility. Further study is needed to clarify the relationship between clarity of near vision and accommodative function in children with brain injury.

Keywords: visual development: infancy and childhood • visual impairment: neuro–ophthalmological disease • refractive error development 
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