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D.W. Lyon, T.R. Candy; Accommodative Performance as a Function of Refractive Error in Infants and Young Children . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1182.
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Abnormal visual experience results in amblyopia, strabismus and poor control of eye growth. A number of studies have considered prescribing spectacles for young hyperopes in an attempt to prevent permanent visual abnormality. Our goal was to estimate the habitual retinal defocus of infants and children as a function of age, refractive error and acuity to determine the levels of refractive error at which visual experience becomes ‘abnormal’.
Infants and children from 6 months to 8 years of age were recruited in a clinical environment. None of the children had had any prior treatment or spectacles. Age, monocular acuity, accommodative accuracy (Nott retinoscopy and a cartoon at 50 cm) and cycloplegic refractive error were all recorded after the parents had given informed consent. The acuities were measured using age–appropriate clinical techniques and converted to Snellen equivalents for the purpose of consistency.
The acuity and refractive error distributions were consistent with the published literature. Using a multiple regression analysis, the subjects’ ages and estimates of acuity were not significantly related to their measured accommodative accuracy in this group of patients. Subjects with 5D or less of hyperopic isoametropia exhibited accommodative lags of no more than 1D. Subjects with larger amounts of hyperopia typically exhibited much larger lags, indicative of significant blur.
The data suggest that a population–based refractive error function for abnormal visual experience can be derived from measures of accommodative accuracy using naturalistic stimuli. This empirical analysis can be used to target the prescribing of preventative spectacle correction.
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