Accommodative Amplitude in School-Age Children

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In children, intensive near-work affects the accommodation system of the eye. Younger children, due to anatomical parameters, read at smaller distance than older children and we can expect that the accommodation system of younger can be affected more than that of older children. We wanted to test this hypothesis. Some authors showed that the norms of amplitude of accommodation (AA) developed by Hofstetter (1950) not always could be applied for children. We also wanted to verify these results. A total of 106 (age 7-15) children participated in the study. Distance visual acuity was measured for all children and only data of children with good visual acuity 1.0 or more (dec. units) were analysed (73 children). Accommodative amplitude was measured before and after lessons using subjective push-up technique (with RAF Near Point Ruler). The results showed that the amplitude of accommodation reduced significantly (p < 0.05) during the day and decrease of AA was similar in different age groups (about ~0.70 D). Additional measurements are needed to verify that the observed changes in AA were associated with fatigue effect. The results showed lower accommodation values compared to average values calculated according to the Hofstetter equation (p < 0.05).

Anderson, H., Stuebing, K. (2014). Subjective versus objective accommodative Amplitude: Preschool to Presbyopia. Optometry Vis. Sci., 91 (11), 1290-1301

Anonymous (2014). Children in Latvia, 2014. Central Statistical Bureau of Latvia, p. 41. Available at: (last accessed 12.11.2016).

Antona, B., Barra, F., Barrio, A., Gonzalez, E., Sanchez, I. (2009). Repeatability intraexaminer and agreement in amplitude of accommodation measurements. Graefes Arch. Clin. Exper. Ophthalm., 247 (1), 121-127.

Atchison, D., Capper, E., McCabe, K. (1994). Critical subjective measurement of amplitude of accommodation. Optom. Vis. Sci., 71 (11), 699-706.

Bababekova, Y., Rosenfield, M., Hue, J. Huang, R. (2011). Font size and viewing distance of handheld smart phones. Optom. Vis. Sci., 88 (7), 795-797.

Bach, M. (2007). The Freiburg Visual Acuity Test-Variability unchanged by post-hoc re-analysis. Graefe's Arch. Clin. Exper. Ophthalmol., 245 (7), 965-971.

Bland, J. M., Altman, D. G. (1986). Statistical methods for assessing agreement between two methods of clinical measurement. Lancet, 1 (8476), 307-310.

Burns, D. H., Evans, B. W., Allen, P. M. (2014). Clinical measurement of amplitude of accommodation: A review. Optometry in Practice, 15 (3), 75-85.

Castagno, V. D., Vilela, M. A., Meucci, R. D., Resende, D. P., Schneid, F. H., Getelina, R., Nasiloski, M. R., Fassa, A. G. (2016). Amplitude of accommodation in schoolchildren. Current Eye Res., 18, 1-7.

Hasebe, S., Graf, E. W., Schor, C. M. (2001). Fatigue reduces tonic accommodation. Ophthalmic Physiol. Optics, 21 (2), 151-160.

Hofstetter, H.W. (1950). Useful age-amplitude formula. World Optom., 38, 42-45.

Ip, J. M., Saw, S. M., Rose, K. A., Morgan, I. G., Kifley, A., Wang, J. J., Mitchell, P. (2008). Role of Near Work in myopia: Findings in a sample of Australian school children. Invest. Ophthalmol. Vis. Sci., 49 (7), 2903-2910.

Iribarren, R., Fornaciari, A., Hung, G. K. (2001). Effect of cumulative nearwork on accommodative facility and asthenopia. Int. Ophthalmol., 24 (4), 205-212.

Jones, L., Sinnott, L., Mutti, D., Mitchell, G., Moeschberger, M., Zadnik, K. (2007). Parental history of myopia, sports and outdoor activities, and future myopia. Investig. Ophthalmol. Visual Sci., 48 (8), 3524-3532.

Marran, L., De Land, P., Nguyen, A. (2006). Accommodative insufficiency is the primary source of symptoms in children diagnosed with convergence insufficiency. Optom. Vis. Sci., 83 (5), 281-289.

Mutti, D., Mitchell, G., Moeschberger, M., Jones, L., Zadnik, K. (2002). Parental yopia, near work, school achievement, and children’s refractive error. Investig. Ophthalmol. Vis. Sci., 43 (12), 3633-3640.

Sterner, B., Gellerstedt, M., Sjöström, A. (2004). The amplitude of accommodation in 6-10-year-old children - not as good as expected! Ophthalmic Physiol. Optics, 24 (3), 246-251.

Taub, M. P., Shallo-Hoffmann, J. (2012). A comparison of three clinical tests of accommodation amplitude to Hofstetter’s norms to guide diagnosis and treatment. Optom. Vis. Devel., 43 (4), 180-190.

Thiagarajan, P., Ciuffreda, K. (2013). Visual fatigue and accommodative dynamics in asymptomatic individuals. Optom. Vis. Sci., 90 (1), 57-65.

Wang, Y., Bao, J., Ou, L., Thorn, F., Lu, F. (2013). Reading behavior of emmetropic schoolchildren in China. Vis. Res., 86, 43-51.

Wolffsohn, J. S., Sheppard, A. L., Vakani, S., Davies, L. N. (2011). Accommodative amplitude required for sustained near work. Ophthalmic Physiol. Optics, 31 (5), 480-486.

Journal Information

CiteScore 2017: 0.22

SCImago Journal Rank (SJR) 2017: 0.127
Source Normalized Impact per Paper (SNIP) 2017: 0.211


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