Bharadwaj SR, Roy S, Satgunam P. Spasm of Near Reflex: Objective Assessment of the Near-Triad.
Invest Ophthalmol Vis Sci 2021;
61:18. [PMID:
32663291 PMCID:
PMC7425728 DOI:
10.1167/iovs.61.8.18]
[Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose
To characterize binocular steady-state accommodation, pupil and convergence responses (near triad) in spasm of near reflex (SNR) before and after optical and pharmacological intervention. To identify the putative source of SNR in the neural control schema of accommodation-vergence interaction using controls-engineering modeling.
Methods
Near-triad of 15 patients with SNR (9 to 23 years) was recorded using an infrared photorefractor at 2m viewing distance for 120s during clinical presentation, after optical fogging intended to relieve spasm, with cycloplegia, post-cycloplegia and long-term follow-up visits. Data were also collected without cycloplegia in 15 age-matched controls. Schor (1999) model was used to computationally simulate accommodation and vergence responses of controls and SNR.
Results
Both eyes of SNR exhibited significant myopia and refraction fluctuations (<1.0Hz) during clinical presentation [median (25th to 75th IQR) refraction: −1.7D (−3.2 to −0.8D); root mean squared (RMS) deviation: 1.1D (0.5 to 1.5D)], relative to controls [0.8D (−0.03 to 1.4D); 0.2D (0.1 to 0.3D)] (p < 0.001). These decreased after optical fogging, largely eliminated with cycloplegia and partially re-appeared in the post-cycloplegia and follow-up visits. SNR responses could be modeled by increasing the gain and decay time of tonic accommodation, vis-à-vis, controls. Pupil and convergence responses in SNR were similar to controls at all visits (p > 0.1).
Conclusions
Exaggerated fluctuations of steady-state accommodation may be a signature feature of SNR, even while their pupil and convergence responses may remain unaffected. These fluctuations may arise from the tonic accommodation controller, the properties of which could be potentially altered after optical fogging to relieve the disorder.
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