Accommodative Dysfunction

Definition:

     Visual Accommodation is the ability to focus by controlling the shape of the lens inside the eye, adjusting appropriately so that objects can be seen clearly at various distances. An accommodative dysfunction is a sensorimotor anomaly of the visual system in the child or young adult under age 40 characterized by poor focusing accuracy; reduced focusing flexibility; focusing spasm (the inability to relax focus); or the inability to sustain clear focus.

Signs and Symptoms:

     The signs and symptoms associated with accommodative dysfunction are related to performance of prolonged visually demanding near-centered tasks. They may include, but are not limited to, the following:

• Transient blurred vision
• Pain in or around the eyes
• Diminished accuracy
• Headaches
• Abnormal postural adaptation/abnormal working distance concentration, and/or awareness
• Inaccurate/ inconsistent visual attention
• Inconsistent work production
• Distractibility while performing visually demanding tasks
• Reduced efficiency and productivity
• Diminished performance with time on task
• Difficulty sustaining near visual function
• Difficulty shifting focus from one distance to another
• General fatigue
• General eye/visual discomfort
• Avoidance of visually demanding tasks
• Illusory movement
• Distance blur after performing near work

Therapeutic Management Considerations:

     The doctor of optometry determines appropriate diagnostic and therapeutic modalities and frequency of evaluation and follow-up, based on the urgency and nature of the patient's conditions and unique needs.

Prescribed Treatment Regimen:

     The goal of the prescribed treatment regimen is to address the underlying condition and alleviate the presenting signs and symptoms. Some cases are successfully managed by the prescription of therapeutic lenses. Most accommodative dysfunctions require optometric vision therapy/orthoptics to develop accurate and effective eye teaming. This condition rarely resolves when left untreated. Treatment duration will depend upon the particular patient's condition and associated circumstances. At the conclusion of the active treatment regimen, periodic follow-up evaluation is required. Therapeutic lenses may be prescribed during or at the conclusion of active vision therapy to assist in the maintenance of long-term stability.