Download Accomodative Dysfunction

ACCOMMODATIVEDYSFUNCTION
Whatisit?
ThetextbookdefinitionforanAccommodativeDysfunctionis:
“Anon‐aging,non‐refractive,neuromuscularabnormalityofthevisualsystem
characterisedbyinadequateaccommodativeaccuracy,facilityandflexibility,
reducedamplitudeofaccommodationortheinabilitytoeasilysustain
accommodation”.
InplainEnglishthissimplymeansthattheindividualhasaproblemsustaining
prolongednearfocus.Thisisnoteyesightorrefractiveerrorproblembutratheran
acquiredfatigueproblemwhichproduceseyestrainandstressparticularlywith
prolongednearwork.
WHATCAUSESAFOCUSINGPROBLEM?
TherearefourpossiblereasonsfordevelopinganAccommodativeDysfunction:
1. PoorGeneralHealth(E.g.ChronicFatigueSyndrome,Glandularfever,badflu
etc.)
2. Asideeffectofsomemedications.(e.g.Ritalin,antihistamines,etc.)
3. Duetoahighdegreeoflong‐sightednessorEyeturn(esp.Esotropia).
4. ThemostcommonreasonisduetoNearPointStressduetoprolongednear
tasks.
 Particularlyifatanagewhereyouhavenotyetdevelopedgoodfocusing
staminatocopewithit.
 Thiscanevenhappenintheadulteye,especiallyifyouaredoinga
stressfulnearcentredtask(egnewjobinvolvingmoreclosework,study,
prolongedcomputerwork,finesewingetc).
SYMPTOMS:
Thesymptomsassociatedwithfocusingdysfunctionareusuallyrelatedtothetaskthat
producesthestress,thatis,prolongednearcentredtasks.Thesymptomsmayinclude,
butarenotlimitedtothefollowing:
 VisualStressSymptoms:Redeyes,soreeyes,transientblurryvisionand/or
headaches.
 Difficultysustainingnearvisualattention:mayactuallyavoidneartask.
 Glaresymptomswhiledoingclosework.(e.g.thepageorcomputerscreen)
 Abnormalpostureadaptationssuchasheadtiltand/ortendtopullthework
closer.
TREATMENT:
1. TrainingSpectaclelensesforallclosework.
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Theproblemisnotthatthingsareconstantlyblurry.Theproblemisthat
thefocusingsystemisworkinghardtokeepitclearandthiscauses
fatigue.
Thetraininglenseshelpalleviateorreducethevisualpointstress.
Themoretheyarewornfornearworkthesoonerbetterfocusingstamina
isdeveloped,thesoonerthespectaclesarenolongerneeded.
2. EyeExercises.(VisualTherapy)
 VisualTherapyonitsownisslowtodevelopaccommodative(focusing)
staminaforthesimplereasonthatforeveryhalfhouroftherapythat
mightbedoneatnighttime,thechild/adulthasusuallybeendoing5or6
hoursof“Anti‐therapy”duringtheday(i.e.demandingcloseworkcausing
accommodativefatigue).
DURATIONOFTREATMENT:
Generallythetraininglensesareneededtobewornforallcloseworkincluding
computerwork,reading,classroomworketc.Theyarenotforoutdoors,TVorfor
constantwear.
TheGoldenRule:Ifyoucantouchitwithyourhandsyoushouldhaveyourtraining
spectaclesontoseeit.
 Mostneedthetrainingspectaclesfor12–18mthsbeforewecanreduceor
eliminatetheneedtowearthemanymore.
 Wewilldoa6weekreviewtoensurethetraininglensesaredevelopingbetter
accommodativestamina.
 IfthereislittleornochangeafterthistimeVisualTherapywillalsobe
considered.
 Thisisonlyneededinabout33%ofcases.
 VisualTherapyrequiresbetween4to6In‐Officevisits(2‐3weeksapart)
alongwithhomebasedactivitiesbeendonebetweenvisits.
 NB:Thesearegeneralisedguidelinesandeachcasemayneedtobeevaluatedon
theindividualbasis.Treatmentdurationwilldependontheparticularpatient’s
condition.
OptionsforVisualTherapy:Pleaseseeourseparateinformationsheet.