Independent development of refraction, accommodation and convergence over two years in primary school children
Purpose: To examine whether age-related changes in refraction covary with changes in parameters describing accommodation and convergence over time in a group of Danish school children.
Methods: Two-hundred and seventy-eight unselected Danish school children (7.1-13.9 years) without manifest strabismus were studied at baseline and after two years. Each examination included measurement of distance visual acuity, unilateral cover test, non-cycloplegic autorefraction, monocular amplitude of accommodation, monocular accommodation facility, near phoria, near point of convergence, and positive and negative fusional vergence. The changes in the measured parameters were studied over time, followed by the testing for dependencies in the development of these parameters.
Results: After two years there was a significant increase in distance visual acuity (p=0.04), monocular accommodation facility (p<0.001), near point exophoria (p=0.04), near point of convergence (p=0.01), and fusional range (p<0.001), a significant reduction in hyperopia (p=0.01) and monocular amplitude of accommodation (p<0.001), while the midpoint of the fusional range changed significantly towards convergence (p<0.001). The increase in near point of convergence correlated significantly with the decrease in monocular amplitude of accommodation (p<0.001) and the convergent shift in the midpoint of the fusional range was significantly correlated with a larger fusional range (p<0.001). The changes in all other parameters were independent.
Conclusions: The development of refraction, accommodation, and convergence parameters in school children over two years are independent. This may be due to separate processes regulating development, and suggests that therapeutic intervention may be performed on each of the parameters individually without a derived effect on the other parameters.
Bharadwaj, S.R., & Candy, T. R. (2008). Cues for the control of ocular accommodation and vergence during postnatal human development. Journal of Vision, 8(16) 14: 1-16. doi:10.1167/8.16.14
Bobier, W.R., & Sivak, J.G. (1983). Orthoptic treatment of subjects showing slow accommodative responses. American Journal of Optometry and Physiological Optics, 60(8), 678-687. doi:10.1097./00006324-198308000-00006
Casillas Casillas, E., & Rosenfield, M. (2006). Comparison of subjective heterophoria testing with a phoropter and trial frame. Optometry & Vision Science, 83(4), 237-241. doi: 10.1097/01.opx.0000214316.50270.24
Evans, B.J.W. (2007). Pickwell's binocular vision anomalies.
Fledelius, HC. (1981). Accommodation and juvenile myopia. Documenta Ophthalmologica Proceedings Series, 28, 103-108. doi:10.1007/978-94-009-8662-6_15
Freier, B.E., & Pickwell, L.D. (1983). Physiological exophoria. Ophthalmic and Physiological Optics, 3(3), 267-272. doi: 10.1016/0275-5408(83)90008-X
Goss, D.A, & Winkler, R.L. (1983). Progression of myopia in youth: age of cessation. American journal of optometry and physiological optics, 60(8), 651-658. doi: 10.1097/00006324-1983308000-00002
Gwiazda, J.E., Hyman, L., Norton, T.T., Hussein, M.E.M., Marsh-Tootle, W., Manny, R., Wang, Y. & Everett, D. (2004). Accommodation and related risk factors associated with myopia progression and their interaction with treatment in COMET children. Investigative Ophthalmology & Visual Science, 45(7), 2143-2151. doi:10.1167/iovs.03-1306
Gwiazda, J., Scheiman, Mitchell, M., Mohindra, I., & Held, R. (1984). Astigmatism in children: changes in axis and amount from birth to six years. Investigative Ophthalmology & Visual Science, 25(1), 88-92. doi: 10.1167/iovs.03-1306
Ingram, R.M, & Barr, A. (1979). Changes in refraction between the ages of 1 and 3 1/2 years. British Journal of Ophthalmology, 63(5), 339-342. doi:10.1136/bjo.63.5.339
Jimenez, R., Gonzalez, M.D., Perez, M.A., & Garcia, J.A. (2003). Evolution of accommodative function and development of ocular movements in children. Ophthalmic and Physiological Optics, 23(2), 97-107. doi:10.1046/j.1475-1313.2003.00093.x
Jimenez, R., Perez, M.A., Garcia, J.A., & Gonzalez, M.D. (2004). Statistical normal values of visual parameters that characterize binocular function in children. Ophthalmic and Physiological Optics, 24(6), 528-542. doi:10.1111/j.1475-1313.2004.00234.x
Lyon, D.W., Goss, D.A., Horner, D., Downey, J.P., & Rainey, B. (2005). Normative data for modified Thorington phorias and prism bar vergences from the Benton-IU study. Optometry-Journal of the American Optometric Association, 76(10), 593-599. doi:10.1016/j.optm.2005.08.014
Maples, Willis C., & Hoenes, R. (2007). Near point of convergence norms measured in elementary school children. Optometry & Vision Science, 84(3), 224-228. doi:10.1097/OPX.0b013e3180339f44
Nisted, I., Maagaard M., & Bek, T. (2013). Independence between age-related changes in refraction, accommodation and convergence in primary school children. Scandinavian Journal of Optometry and Visual Science, 6(2), 6-9. doi:10.5384/SJOVS.vol6i2p6
Scheiman, M., Cotter, S., Kulp, M.T., Mitchell, G.L., Cooper, J., Gallaway, M., Hopkins, K.B., Bartuccio, M. & Chung, I. (2011). Treatment of Accommodative Dysfunction in Children: Results from a Randomized Clinical Trial. Optometry & Vision Science, 88(11), 1343-1352. doi:10.1097/OPX.0b013e31822f4d7c
Scheiman, M., Herzberg, H., Frantz, K., & Margolies, M. (1988). Normative study of accommodative facility in elementary schoolchildren. American Journal of Optometry and Physiological Optics, 65(2), 127-134. doi:10.1097/00006324-198802000-00009
Schor, Clifton M. (2011). Neural control of eye movements. Adlers Physiology of the Eye, 10, 830-858. doi:10.1016/B978-0-323-05714-1.00009-1
Walline, J.J., Mutti, D.O., Zadnik, K., & Jones, L.A. (1998). Development of phoria in children. Optometry & Vision Science, 75(8), 605-610. doi:10.1097/00006324-199808000-00026
Williams, C., Miller, L., Northstone, K., & Sparrow, J.M. (2008). The use of non-cycloplegic autorefraction data in general studies of children's development. British Journal of Ophthalmology, 92(5), 723-724. doi:10.1136/bjo.2007.136051