Accommodative function in school children with reading difficulties



Prior findings suggest correlation between reading problems and accommodative function, but few studies have assessed accommodation in children with poor reading skills. Our aim was to characterize monocular accommodative amplitude, relative accommodation and binocular accommodative facility in a population of healthy, non-dyslexic primary school children with reading difficulties.


We conducted a cross-sectional study on 87 poor readers and 32 control children (all between 8 and 13 years of age) in grades three to six recruited from 11 elementary schools in Madrid, Spain. In each subject with best spectacle correction, negative relative accommodation (NRA) and positive relative accommodation (PRA) were measured using a phoropter, monocular accommodative amplitude (MAA) was determined using the minus lenses method, and binocular accommodative facility (BAF) was measured using the Bernell Acuity Suppression Slide (VO/9) and a ± 2.00 D accommodative demand for a period of 1 minute.


Monocular accommodative amplitude was significantly lower (p < 0.001) in the group of poor readers (right eye 9.1 D ± 2.3, left eye 9.0 D ± 2.3) than in the control group (right eye 10.5 D ± 1.7, left eye 10.5 D ± 1.7). Binocular accommodative facility values were significantly lower (p < 0.05) in the poor readers (4.9 cpm ± 3.1) than controls (6.3 cpm ± 2.9). Negative and positive relative accommodation values were similar in both groups of children.


This study provides data on the accommodative capacity of a population of children with reading difficulties. Our findings suggest a reduced monocular accommodative amplitude and binocular accommodative facility, such that this function should be assessed by an optometric clinician in children whose reading level is below average.

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This research was supported by a grant from PRATS-OPTICAL S.A. The authors would like to thank Miguel Florido and Visual Global for logistic support, and the following schools in Madrid for their collaboration: El Prado, Chamberí, Blanca de Castilla, San Rafael Arcangel, Sagrado Corazón, Luyferivas, SEK Santa Isabel, Santo Angel de la Guarda, Valdeluz, Virgen de Mirasierra and Las Tablas. We also gratefully acknowledge the children who participated in this study and their parents.

The authors have no commitments with the company that supported this research with respect to the results obtained.

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Correspondence to Catalina Palomo-Álvarez.

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Human subjects and informed consent

The authors confirm that this research was performed followed the tenets of the Declaration of Helsinki, and that informed consent was obtained from the subjects after having explained to them in detail the nature of the study. The study protocol was approved by the Clinical Research Ethics Committee of the School of Optometry.

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Palomo-Álvarez, C., Puell, M.C. Accommodative function in school children with reading difficulties. Graefes Arch Clin Exp Ophthalmol 246, 1769–1774 (2008).

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  • Accommodative function
  • Poor readers
  • School-age children
  • Monocular accommodative amplitude
  • Relative accommodation
  • Binocular accommodative facility