Documenta Ophthalmologica

, Volume 55, Issue 3, pp 177–198 | Cite as

Accommodative dysfunction

  • K. M. Daum


A retrospective review of the records of 114 subjects with accommodative dysfunction has been completed. Most subjects (N = 96) were found to have accommodative insufficiency. Lesser numbers of subjects were categorized in the class of infacility of accommodation (N = 14), spasm of accommodation (N = 3) and fatigue of accommodation (N = 1). A majority of the subjects presented with complaints of blur, headaches and/or asthenopia while attempting nearwork. Most subjects presented with reduced abilities in one or more of the following areas: accommodative amplitude and facility, fusional vergences, near point of convergence and stereo acuities. The clinical characteristics of the group as a whole and the major subgroups have been examined both before and after treatment of the condition with orthoptic exercises and/or plus lenses at the nearpoint. The result of the treatment indicates that although most subjects (96%) experienced some relief with treatment only about half (53%) had their problems totally solved. The importance of these findings is briefly discussed.

Key words

accommodation accommodative dysfunction accomodative insufficiency premature presbyopia infacility of accommodation tonic accommodation blur headaches asthenopia orthoptics 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Alexander G (1940) Spasm of Accommodation. Trans Ophthal Soc UK 60:207–212Google Scholar
  2. Alpers B and Palmer H (1929) The cerebral and spinal complications occurring during pregnancy and the puerperium. J Nerv Ment Dis 70:465–484Google Scholar
  3. Anderson M (1961) Orthoptic treatment of loss of convergence and accommodation caused by road accidents (“Whiplash” injury). Brit Orthopt J 18:117–120Google Scholar
  4. Berens C (1929) An accommodation ergograph. Trans Amer Acad Ophthal Otolaryng 34:472–478Google Scholar
  5. Berens C, Connolly P and Kern D (1933) Certain motor anomalies of the eye in relation to prescribing lenses. Amer J Ophthal 16:199–213Google Scholar
  6. Berens C, and Sells S (1944) Experimental studies on fatigue of accommodation I. Arch Ophthal 31:148–159Google Scholar
  7. Berens C and Stark E (1932a) Studies in ocular fatigue III. Amer J Ophthal 15:216–223Google Scholar
  8. Berens C and Stark E (1932b) Studies in ocular fatigue IV. Amer J Ophthal 15:527–542Google Scholar
  9. Bernstein F and Bernstein M (1945) Law of physiologic aging as derived from long range data on refraction of the human eye. Arch Ophthal 34:378–388Google Scholar
  10. Blatt N (1931) Weakness of accommodation. Arch Ophthal 5:362–373Google Scholar
  11. Borish I (1970) Clinical Refraction 3rd ed. Chicago, Professional Press pp 149–188Google Scholar
  12. Brownell M (1941) Paresis of accommodation due to dental caries. Arch Ophthal 26:1057–1058Google Scholar
  13. Donders FC (1864) On the Anomalies of Accommodation and Refraction of the Eye. London, The New Sydenham SocietyGoogle Scholar
  14. Duane A (1916) Anomalies of accommodation clinically considered. Arch Ophthal 45:124–136Google Scholar
  15. Duane A (1922) Studies in monocular and binocular accommodation with their clinical applications. Amer J Ophthal 5:865–877Google Scholar
  16. Duane A (1925) Subnormal accommodation. Arch Ophthal 54:566–587Google Scholar
  17. Duane A (1931) Accommodation, Arch Ophthal 5:1–14Google Scholar
  18. Duke-Elder S (ed) (1970) System of Ophthalmology, Vol V Ophthalmic Optics and Refraction. St Louis, Mosby, pp 451–486Google Scholar
  19. Ferree C (1914) The efficiency of the eye under different systems of lighting. Ophthalmology (Seattle) 10:622–637Google Scholar
  20. Gould G (1905) Premature presbvopia. Amer Med 9:103–108Google Scholar
  21. Griffin J (1976) Binocular Anomalies: Procedures for Vision Therapy. Chicago, Professional PressGoogle Scholar
  22. Hammerburg E and Norn M (1972) Defective dissociation of accommodation and convergence in dyslectic children. Acta Ophthal 50:651–654Google Scholar
  23. Helwig J and Council K (ed) (1979 edition) SAS User's Guide, SAS Institute, Inc. Cary, North CarolinaGoogle Scholar
  24. Hofstetter H (1942) Factors involved in low amplitude cases. Amer J Optom Arch Amer Acad Optom 19:279–289Google Scholar
  25. Hofstetter H (1943) An ergographic analysis of fatigue of accommodation. Amer J Optom Arch Amer Acad Optom 20:115–135Google Scholar
  26. Howe L (1916) The fatigue of accommodation as registered by the ergograph. J Amer Med Ass 67:100–104Google Scholar
  27. Howe L (1917) On varieties of the fatigue of accommodation as registered by the ergograph. Trans Amer Ophthal Soc 15:145–153Google Scholar
  28. Irvine G (1947) A study of esophoria and ciliary spasm. Brit J Ophthal 31:289–304Google Scholar
  29. Lancaster W and Williams E (1914) New light on the theory of accommodation, with practical applications. Trans Amer Acad Ophthal Otolaryng 19:170–195Google Scholar
  30. Lieppman M (1981) Accommodative and convergence insufficiency after decompression sickness. Arch Ophthal 99:453–456Google Scholar
  31. Liu J, Lee M, Jang J, Ciuffreda K, Wong J, Grisham D and Stark L (1979) Objective assessment of accommodation orthoptics I. Dynamic insufficiency. Amer J Optom Physiol Opt 56:285–294Google Scholar
  32. Manson N and Stern G (1965) Defects of near vision in myasthenia gravis. Lancet 1:935–937Google Scholar
  33. Marlow F (1922) Persistent accommodative spasm due to latent hyperphoria. Arch Ophthal 51:223–226Google Scholar
  34. Mathur J and Vaithilingam E (1970) Accommodative insufficiency and anaemia. Optician 160:396–397Google Scholar
  35. Morris C (1959) A theory concerning adaptation to accommodative impairment. Optometric Weekly 50:255–262Google Scholar
  36. Prakash P, Agarwal L and Nag S (1972) Accommodational weakness and convergence insufficiency. Orient Arch Ophthal 10:261–264Google Scholar
  37. Prangen A (1922) Spasm of accommodation with report of 30 cases. Transactions of the section on Ophthalmology of the American Medical Association of the 82nd Annual Session, AMA Press, pp 282–292Google Scholar
  38. Prangen A (1931) Subnormal accommodation. Arch Ophthal 6:906–918Google Scholar
  39. Prangen A (1937) Some problems and procedures in refraction. Arch Ophthal 18:432–447Google Scholar
  40. Slataper F (1950) Age norms of refraction and vision. Arch Ophthal 43:466–481Google Scholar
  41. Sollam A (1966) Unilateral spasm of accommodation and transient convergent squint due to an anxiety neurosis. Brit Orth J 23:118–119Google Scholar
  42. Sumner P (1921) Subnormal accommodation: the result of focal infection. Amer J Ophthal 4:356–357Google Scholar
  43. Theobald S (1894) Some typical cases of “subnormal accommodative power”. Trans Amer Ophthal Soc 7:138–142Google Scholar
  44. Thal L, Phillips S and Stark L (1977) Paralysis of accommodation in infectious mononucleosis. Amer J Optom Physiol Opt 54:19–26Google Scholar
  45. Tucker J and Tomlinson A (1974) An investigation of persistent paresis of accommodation. Amer J Optom Physiol Opt 51:3–11Google Scholar
  46. Veasey D (1919) Paralysis of accommodation. Trans Amer Ophthal Soc 17:440–441Google Scholar
  47. Volkov V and Kolesnikova L (1972) Treatment of an accommodative spasm with no immediate association with the weakness of the ciliary muscles. Vestn Oftal 1:50–52Google Scholar
  48. Von Noorden G, Brown D and Parks M (1973) Associated convergence and accommodative insufficiency. Docum Ophthal 34:393–403Google Scholar
  49. Walker J (1946) Myopia and pseudo-myopia. Brit J Ophthal 30:735–742Google Scholar
  50. Walsh F and Hoyt W (1969) Clinical Neuro-ophthalmology, 3rd ed. Baltimore, Williams and Wilkins, pp 544–551Google Scholar
  51. Westcott V (1943) Concerning the accommodation before and after head injury. Illinois Med J 183:170–172Google Scholar
  52. White J (1921) Paralysis of acommodation following a peritonsillar abscess. Amer J Ophthal 4:276–277Google Scholar
  53. Wilmer W and Berens C (1918) V, The effect of altitude on ocular functions. J Amer Med Ass 71:1394–1398Google Scholar
  54. Wood D (1920) Accommodative failure in malaria and influenze. Brit J Ophthal 4:415–416Google Scholar

Copyright information

© Dr W. Junk Publishers 1983

Authors and Affiliations

  • K. M. Daum
    • 1
  1. 1.College of Optometry, The Ohio State UniversityColumbusUSA

Personalised recommendations