Influence of target color and vergence of light on ocular accommodation during binocular fixation

Congenitally Impaired Disparity Vergence in Children With Infantile Esotropia

Purpose

We examined whether congenital impairment of disparity vergence in infantile esotropia (ET) exists in children with short duration ET (≤3 months) compared with long-duration ET and healthy controls. A short duration of misalignment would allow for a substantial amount of balanced binocular input during the critical period of binocular disparity development.

Methods

A total of 19 children aged 5 to 12 years and treated for infantile ET with a short (≤3 months; n = 10) or long (≥5 months; n = 9) duration of constant misalignment before alignment were enrolled. A total of 22 healthy control children were enrolled as a comparison group. Eye movements during disparity vergence and accommodative vergence were recorded using an EyeLink 1000 binocular eye tracker. Mean response gain was compared between and within groups to determine the effect of duration of misalignment and viewing condition.

Results

Compared with controls, children with short (P = 0.002) and long (P < 0.001) duration infantile ET had reduced response gains for disparity vergence, but not for accommodative vergence (P = 0.19).

Conclusions

Regardless of duration of misalignment, children with infantile ET had reduced disparity vergence, consistent with a congenital impairment of disparity vergence in infantile ET. Although early correction of misalignment increases the likelihood that some level of binocular disparity sensitivity will be present, normal levels may never be achieved.

Effect of Vision Therapy on Accommodation in Myopic Chinese Children

Introduction. We evaluated the effectiveness of office-based accommodative/vergence therapy (OBAVT) with home reinforcement to improve accommodative function in myopic children with poor accommodative response. Methods. This was a prospective unmasked pilot study. 14 Chinese myopic children aged 8 to 12 years with at least 1 D of lag of accommodation were enrolled. All subjects received 12 weeks of 60-minute office-based accommodative/vergence therapy (OBAVT) with home reinforcement. Primary outcome measure was the change in monocular lag of accommodation from baseline visit to 12-week visit measured by Shinnipon open-field autorefractor. Secondary outcome measures were the changes in accommodative amplitude and monocular accommodative facility. Results. All participants completed the study. The lag of accommodation at baseline visit was 1.29 ± 0.21 D and it was reduced to 0.84 ± 0.19 D at 12-week visit. This difference (−0.46 ± 0.22 D; 95% confidence interval: −0.33 to −0.58 D) is statistically significant (p < 0.0001). OBAVT also increased the amplitude and facility by 3.66 ± 3.36 D (p = 0.0013; 95% confidence interval: 1.72 to 5.60 D) and 10.9 ± 4.8 cpm (p < 0.0001; 95% confidence interval: 8.1 to 13.6 cpm), respectively. Conclusion. Standardized 12 weeks of OBAVT with home reinforcement is able to significantly reduce monocular lag of accommodation and increase monocular accommodative amplitude and facility. A randomized clinical trial designed to investigate the effect of vision therapy on myopia progression is warranted.

Dynamic accommodation responses to stationary colored targets

PURPOSE

When the targets or the background in a display are different colors, longitudinal chromatic aberration ensures that there is no single correct accommodative response. The purpose of the present study was to determine whether the response becomes more variable when viewing certain multicolor displays.

METHODS

Accommodative responses of five young participants were measured with a dynamic infrared optometer while they viewed steady targets at a nominal stimulus level of 3 D. Target-on-background color combinations were black on white, black on blue, black on red, blue on red, red on blue, dark blue on red, and dark red on blue.

RESULTS

When compared with the standard black-on-white target, responses to targets with reduced spectral bandwidth were not significantly more variable. In most participants, responses to near-isoluminant targets (e.g., red on blue and blue on red) were not more variable than to the standard target. However, calculated confidence intervals cannot rule out moderate to large changes in variability near isoluminance. Responses to these multicolor targets tended to favor the blue focus.

CONCLUSIONS

In most individuals, viewing multichromatic targets does not increase significantly the variation in accommodative response as compared with broadband black-and-white targets.

Isolated short-wavelength sensitive cones can mediate a reflex accommodation response

Both long- and middle-wavelength sensitive cones mediate the reflex accommodation signal but the contribution from the short-wavelength sensitive cones is unknown. A short-wavelength sensitive cone contribution could extend the range of the signed defocus signal from chromatic aberration. The aim was to determine whether isolated short-wavelength sensitive cones mediate reflex accommodation independently of long- and middle-wavelength sensitive cones. Accommodation was monitored continuously (eight subjects) to a sine-wave grating (3 cpd; 0.53 contrast) moving with a sum of sines motion in a Badal optometer. Two illumination conditions were used: a 'blue' condition that isolated short-wavelength sensitive cones, and a 'white' control condition that stimulated all three cone types. Of the eight subjects, two responded equally in the 'white' and 'blue' condition, four gave reduced responses in the 'blue' condition and two failed to respond in both conditions. The mean response in the 'blue' condition was reduced by 50% compared to the 'white' condition. Further analysis indicated that four of the eight subjects gave responses that were considerably greater than noise (S.D.>1.82) when short-wavelength sensitive cones were isolated. Some subjects can accommodate using only S-cones.

Accommodation without feedback suggests directional signals specify ocular focus

Accommodation was monitored continuously under open-loop conditions while subjects viewed a sinusoidally oscillating sine-wave grating (0.2 Hz; +/- 1 D; 2.7 c/d; 0.56 contrast) in a Badal optometer. The target was illuminated by monochromatic light (590 nm) or white light (3000 K) with longitudinal chromatic aberration (LCA) normal, doubled, neutralized and reversed. Subjects (12) accommodated well in white light with LCA normal and doubled (mean gains = 0.85 and 0.94), gain was reduced in the neutralized condition (0.54), in monochromatic light (0.43), and especially when LCA was reversed (0.30). The results suggest that accommodation responds to changes in the relative contrast of spectral components of the retinal image and perhaps to the vergence of light.

A dynamic relationship between myopia and blur-driven accommodation in school-aged children

Previously we reported that recently myopic children accommodated insufficiently to blur induced by negative lenses. The purpose of the present study was to relate changes in blur-driven accommodation to myopia development in children. Refractive errors and the accommodation response function (ARF) were measured in 23 myopic and 40 emmetropic children on two occasions separated by periods ranging from 6 to 12 months. Repeated measures of accommodation were made with a Canon R-1 autorefractor while negative lenses of increasing power were placed in front of the child's right eye viewing 20/100 letters at 4 m. Concomitant changes in refractive error and in accommodative function over periods of 6-12 months were found to be highly correlated in myopes (r = 0.77) but not in emmetropes (r = 0.09).