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Ryan Nelson Chinn, Emily Wiecek, Aparna Raghuram; Influence of Hyperopic Refractive Error on Accommodation in Post-Concussion Adolescent Patients. Invest. Ophthalmol. Vis. Sci. 2019;60(9):1804.
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Deficits in accommodation have been reported in post-concussion adolescent patients and it has yet to be determined if uncorrected refractive error further contributes to these deficits. Studies are needed to address if small uncorrected refractive error, especially hyperopia, improve visual function and symptoms in post-concussion patients. This study explores the relationship between the frequency of hyperopic refractive error and accommodation deficits in post-concussion adolescents.
A retrospective analysis was conducted on concussion patients seen at Boston Children’s Hospital either by the multidisciplinary concussion clinic or referred to the last author for an evaluation. Three hundred and seventy four records were reviewed from August 2012 to September 2018 to fit the inclusion criteria of < 22 years of age, 20/30 vision or better in each eye, no strabismus, amblyopia or other ocular pathology. Each patient received a comprehensive eye examination and tests to assess vergence, accommodation, and tracking.
The review yielded 274 records that fit the inclusion criteria, 100 were males. The patients were seen at a median 111.5 days following concussion with 59% from sports related event and 53% reporting it to be their first. 187 had hyperopia > =0.25 D; [0.89 D ±0.68]; 70 had myopia >= -0.25 D [-1.69D ±1.74] and 17 had emmetropia based on spherical equivalent refractive error. In the 187 hyperopes, 9 had significant refractive error warranting full time glasses. The remaining 178 hyperopes [0.78D ±0.39] – 119 were recommended to use glasses for near work of whom 80 had diagnosed accommodative dysfunction (AD), defined as having two or more of the following deficits: accommodative insufficiency, accommodative infacility or accommodative inaccuracy. In total 64% (114/178) of the hyperopes were found to have AD. Eye exercises for improving accommodation were recommended along with glasses in 47 patients. Of the remaining 59 who were hyperopic and not prescribed glasses, 34 had diagnosed AD, and 26 of them were given eye exercises to improve accommodation.
Correcting small hyperopic refractive errors ≤ +1.50 D can improve accommodative function, support relieving symptoms, and shorten the path to recovery in post-concussion adolescent patients. Prospective control studies are needed to further validate this position as evidence based treatment recommendation.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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