Comparison of Short-Term Effects of Treatment of Accommodative Infacility with Low Plus Addition in Single Vision Rx or Vision Therapy: A Pilot Study

Figures & data

Table 1 Normative Values for Subjects Aged 8–12 Years⁵

	Average	Standard Deviation	Minimum Expected
MAF (+2D/-2D at 40 cm)	7.0 cpm	± 2.5 cpm	4.5 cpm
BAF (+2D/-2D at 40 cms)	5.0 cpm	± 2.5 cpm	2.5 cpm
Accommodative amplitude Push-up (Hofstetter)	18 D – age*0.30		15 D – age*0.25
MEM-Retinoscopy	+0.25 D to +0.75 D		+0.25 D
Negative relative accommodation (NRA)	+2.00 D	± 0.50 D	+ 1.50 D
Positive relative accommodation (PRA)	−2.37 D	± 1.00 D	−1.37 D

Table 2 Demographics and Refractive Status of Participants

	ADD (n = 10)	VT (n = 9)	p-value
Female gender [n (%)]	5 (26.3)	7 (36.8)	0.210^a
Age (yr) [median (IQR)]	9.0 (4.0)	11.0 (2.5)	0.356
Range	8–12	8–12
Refraction RE: [median (IQR)]
Sphere (DS)	0.00 (0.50)	0.00 (0.87)	0.905
Cylinder (DC)	0.00 (0.50)	0.00 (0.37)	0.780
Sph.equiv. (D)	0.00 (0.50)	0.00 (0.81)	0.968
Visual acuity^b RE [median (IQR)]	1.0 (0.0)	1.0 (0.2)	0.315
Refraction LE: [median (IQR)]
Sphere (DS)	0.00 (0.50)	0.00 (0.62)	0.780
Cylinder (DC)	0.00 (0.31)	0.00 (0.62)	0.661
Sph.equiv. (D)	0.00 (0.72)	0.00 (0.94)	0.780
Visual acuity^b LE [median (IQR)]	1.0 (0.0)	1.0 (0.2)	0.356
Visual acuity^b BIN [median (IQR)]	1.0 (0.0)	1.0 (0.2)	0.400

Notes: Statistical comparisons of groups were performed by means of Mann–Whitney-U and ^aChi-Square tests. ^bSnellen decimal visual acuity.¹⁸

Abbreviation: RE, Right eye; LE, Left eye; BIN, Binocular; IQR, interquartile range.

Table 3 Binocular Status of Participants

	ADD (n = 10)	VT (n = 9)	p-value
Accommodation amplitude (D) [median (IQR)
Right eye	12.0 (2.5)	11.5 (2.0)	0.905
Left eye	11.5 (1.6)	12.0 (1.7)	0.661
NPC (cm) [median (IQR)]	5.5 (2.0)	8.0 (2.5)	0.035
Range	5–8	5–10
NRA (D) [median (IQR)]	1.50 (0.25)	1.50 (0.37)	0.842
PRA (D) [median (IQR)]	−1.50 (0.50)	−1.50 (0.37)	0.780
Accommodative response by MEM retinoscopy (D) [median (IQR)]
Right eye	0.50 (0.25)	0.50 (0.13)	0.780
Left eye	0.50 (0.00)	0.50 (0.13)	0.720
BCC (D) [median (IQR)]	0.50 (0.40)	0.30 (0.40)	0.156
Phoria^a (PD) [median (IQR)]
Distance	0.5 (2.5)	0.0 (2.5)	0.661
Near	−4.0 (1.5)	−4.0 (3.0)	0.968
AC/A [median (IQR)]	4.0 (0.6)	4.3 (0.8)	0.549
Stereoacuity^b (arc min) [median (IQR)]	60 (0)	60 (15)	0.661

Notes: Statistical comparisons of groups were performed by means of Mann–Whitney U test. ^aExophoria = negative values, Esophoria = positive values, ^bTNO Stereo Test.

Abbreviation: IQR, interquartile range.

Table 4 Baseline Measurements

	ADD (n = 10)	VT (n = 9)	p-value
Accommodative facility (+2D/-2D at 40 cm):
MAF-R (cpm) [median (IQR)]	3.00 (1.25)	2.00 (2.25)	0.720
MAF-L	3.00 (1.00)	2.00 (1.00)	0.243
BAF	2.25 (1.50)	2.00 (1.25)	0.315
Symptoms: CISS [median (IQR)]	27.50 (6.25)	27.00 (7.50)	1.000

Note: Statistical comparisons of groups were performed by means of Mann–Whitney U test.

Abbreviation: IQR, interquartile range.

Table 5 Comparison of Outcome Measurements Before and After 6 Weeks of Treatment

	Baseline	+6 Weeks	p-value
ADD (n = 10)
MAF-R (cpm) [median (IQR)]	3.00 (1.25)	7.50 (5.75)	0.008
MAF-L	3.00 (1.00)	7.50 (5.50)	0.008
BAF (+2D/-2D at 40 cm)	2.25 (1.50)	5.50 (6.75)	0.005
CISS [median (IQR)]	27.50 (6.25)	17.50 (10.25)	0.008
VT (n = 9)
MAF-R (cpm) [median (IQR)]	2.00 (2.25)	9.00 (8.75)	0.008
MAF-L	2.00 (2.00)	9.00 (7.00)	0.008
BAF (+2D/-2D at 40 cm)	2.00 (1.25)	12.00 (8.00)	0.008
CISS [median (IQR)]	27.00 (7.50)	10.00 (15.00)	0.008

Note: Statistical comparison was performed by means of Wilcoxon signed rank test.

Abbreviation: IQR, interquartile range.

Figure 1 Change of MAF and BAF after 6 weeks of treatment with ADD or VT. The boxplot represents the interquartile range and the median value. Whiskers indicate range of values, excluding outliers. Statistical comparison of groups was performed by means of Mann–Whitney U test.

Figure 2 Change of CISS after 6 weeks of treatment with ADD or VT. The boxplot represents the interquartile range and the median value. Whiskers indicate range of values, excluding outliers. Statistical comparison of groups was performed by means of Mann–Whitney U test.

Scheiman M, Wick B. Clinical Management of Binocular Vision: Heterophoric, Accommodative, and Eye Movement Disorders. Fifth ed. Lippincott Williams & Wilkins; 2020.

 Google Scholar

Clinical guidelines, Standard Optometric Examination (2017) of the Norwegian Association of Optometry (NAO), [Kliniske retningslinjer - Rutineundersøkelser R1 (2017), Norges Optikerforbund]. Available from: https://www.optikerne.no/getFile.php?ID=5a0bef51c9e6dee843fc62c0b9aceb4c39031179168594dcfd25ad2b418134e44095f064. Accessed April 7, 2022.

 Google Scholar