Clues for the Diagnosis of Accommodative Excess and Its Treatment with a Vision Therapy Protocol

Introduction: Accommodative and vergence dysfunctions are the most common vision disorders in the pediatric population with a prevalence of up to 30%, and patients with these dysfunctions usually have symptoms at near distances that could affect academic results. This study is the retrospective assessment of accommodative excess cases and aims to find a pattern in optometric exams to help diagnose accommodative excess without cycloplegic drugs. Furthermore, this study assesses the utility of a vision therapy protocol as accommodative excess treatment.

Methodology: A retrospective study was conducted with 24 patients who were diagnosed with accommodative excess and completed all sessions of the vision therapy protocol. The vision therapy protocol was organized into 8-12 sessions. Statistical analysis was performed using SPSS 23.0. Wilcoxon nonparametric paired tests were used to compare the clinical values between visits.

Results: In total, 24 patients with accommodative excess were included in the retrospective study. The pairwise comparisons of sphere values obtained with the different refraction methods without cycloplegic drugs found statistically significant differences (P< 0.01). Statistically significant differences (P< 0.01) were shown in the sphere values obtained from subjective refraction, visual acuity tests, near point of convergence and stereopsis between the diagnosis visit and the post-vision therapy protocol visit, with better values post-therapy.

Conclusion: Variations in the sphere values could be clues for accommodative excess if a double condition is given, the retinoscopy results are more positive than the subjective refraction findings (>0.60D) and are more positive than the values obtained with an auto refractor (>1.75D).