Effect of Peripheral Optical Quality in Accommodation Responses of Young Children

Abstract

Purpose : The optical quality in the near periphery has been associated with refractive error development. We investigated whether peripheral optical quality in children at High (HR) or Low Risk (LR) for myopia affects their accommodation responses.

Methods : Young children (n=97, 7.58±0.96yrs) with functional emmetropia (SE OD +0.95±0.54D; AXL OD 22.79±0.75mm) were enrolled. Optical quality across the central horizontal ±30° was assessed using a scanning aberrometer. Strehl ratios, Defocus (Z4) and primary Spherical Aberration (SA, Z12) were computed for 4mm diameter pupils. Accommodation responses were assessed with an open-field WAM binocular autorefractor for a central target at 40cm (20° ‘dead leaves’ that mimic natural images). Linear regression models were used to test if the optical quality measures predicted accommodation responses, for all subjects and also when divided into HR and LR, based on parental myopia and baseline SE.

Results : Peripheral Strehl ratios significantly predicted central accommodation responses for the LR group (temporal retina: R²=0.31, p=0.04; T25deg: β=-14.04, p=0.04; nasal retina: R²=0.45, p<0.01; N10deg: β=-4.29, p<0.01), but not for children at HR for myopia. Central accommodation was also predicted by peripheral SA (temporal: R²=0.335, p=0.05; nasal: R²=0.48, p<0.01), and central SA (0deg: R²=0.43, p<0.01). When split into LR and HR groups, only the nasal retina significantly affected accommodation responses for the LR group at N5deg (β=-7.97, p=0.03). Lastly, central accommodation was predicted by peripheral Defocus (nasal: R²=0.48, p<0.01; temporal: R²=0.39, p=0.02) and central Defocus (R²=0.43, p<0.01). When split into HR and LR groups, nasal Defocus predicted accommodation responses only for the HR group (R²=0.55, p<0.01). No significant differences were found between HR and LR groups in Strehl ratios, Defocus or SA, although a trend for more positive Defocus was found in the HR group and more positive SA (significant for T25deg and T15deg) in the LR group across the periphery.

Conclusions : Peripheral optical quality is associated with central accommodation responses in young children with functional emmetropia. Accommodation responses in children at LR for myopia are affected by their peripheral Strehl ratios and SA, and those at HR for myopia by peripheral Defocus. Peripheral optical quality, particularly in the nasal retina, may have implications in myopia development.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.