Purchase this article with an account.
LA Ostrin, J Wold, A Glasser; Pilocarpine Stimulated Accommodation in Humans . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2317.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose: There is considerable interest in new surgical procedures aimed at restoring accommodation in presbyopes, however accommodation is generally only measured with the subjective push-up technique which does not unequivocally demonstrate a dioptric change in power of the eye. Accommodation can be stimulated with topically applied pilocarpine and the accommodative response measured over time with a refractometer. Tests have been undertaken to pharmacologically stimulate accommodation in normal young, pre-presbyopic and presbyopic human subjects and to measure the time-course and amplitude of the responses. Methods: 45 subjects, age 23 - 53 (mean age 39), participated. Accommodative amplitude was first measured subjectively. Subjects reported when they could no longer clear a distant letter chart viewed through increasingly powered minus lenses (minus to blur). Refraction was then measured objectively in the right eye using a Hartinger coincidence refractometer (Zeiss, Germany) while accommodation was stimulated with 1) increasing powered minus lenses placed in front of the contralateral eye to induce a consensual accommodative response and 2) with 6% pilocarpine instilled topically in the right eye. Following instillation of pilocarpine, refraction was measured three times every five minutes for one hour. Results: Maximum accommodation of about 10D was stimulated with 6% pilocarpine in young subjects with an age dependent decline in amplitude to 0D in the oldest subjects. Maximal accommodation occurred at between 20 - 30 minutes after pilocarpine administration. Subjects with light irides showed stronger accommodative responses than subjects with darkly pigmented irides. The relationship between maximum pharmacologically stimulated accommodative amplitude and the amplitude measured subjectively and objectively when stimulated with minus to blur varied as a function of iris pigmentation. Conclusion: The accommodative response stimulated in normal human subjects with topically applied pilocarpine depends not only on age, but also on iris pigmentation. While the presence of accommodation can be established objectively with pilocarpine stimulation in normal subjects, conclusions about the amplitudes achieved must take account of differences due to iris pigmentation.
This PDF is available to Subscribers Only