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

Abstract

Purpose

To compare the short-term treatment effect of low plus reading addition (ADD) and home-based vision therapy (VT) in a small group of symptomatic children with accommodative infacility (AIF) being the most significant dysfunction.

Methods

Nineteen children, 8 to 12 years of age, with a first-time diagnosis of AIF were consecutively and alternately allocated to treatment with ADD (+0.50 D addition in single vision Rx) or VT (accommodation exercises using Hart Charts) for a period of 6 weeks. Accommodation facility (AF) was measured monocularly (MAF-R, MAF-L) and binocularly (BAF) with +2 D/-2 D flipper and registered in cycles per minute (cpm). Symptoms were graded using the convergence insufficiency symptom survey (CISS). Measurements were compared before and after treatment and between groups using nonparametric statistics (p < 0.05).

Results

Ten children were allocated to ADD (median age 9.0 F:5) and 9 to VT (median age 11.0 F:7). Baseline median measurements of MAF-R, MAF-L, BAF and CISS were 3.0, 3.0, 2.2 cpm, and 27.5 points, respectively, for ADD, and 2.0, 2.0, 2.0 cpm, and 27.0 points, respectively, for VT. There were no significant differences between groups at baseline. After 6 weeks of treatment, the median change of MAF-R, MAF-L, BAF and CISS was +5.0, +4.5, +4.7 cpm, and –7.5 points, respectively, for ADD and +8.0, +8.0, +10.0 cpm, and –20.0 points, respectively for VT. All changes within groups were significant. Comparison of groups showed a significantly greater effect of treatment with VT compared to ADD for BAF (p = 0.008) and CISS (p = 0.017).

Conclusion

In children with newly diagnosed AIF, treatment with accommodation exercises for 6 weeks gives greater short-term relief of symptoms and improvement of binocular accommodative facility compared to treatment with spectacle single vision correction with a weak plus addition.

Keywords:

• accommodative dysfunction
• infacility
• +2/-2 flipper
• Hart Chart
• CISS

Acknowledgments

Our acknowledgement goes to the study participants and their parents/guardians for their willingness to take part in this study. Data published in this article has been presented as a conference abstract at ARVO Annual Meeting in 2018.

Disclosure

Göran Skjöld is via HB Sekon, the distributor of HTS software in the Nordic countries. The authors report no other conflicts or competing interest in this work.