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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Flax N (1970) The contribution of visual problems to learning disability. J Am Optom Assoc 41:841–845
Sucher D, Stewart J (1993) Vertical fixation disparity in learning disabled. Optom Vis Sci 70:1038–1043, doi:10.1097/00006324–199312000–00008
Sterner B, Gellerstedt M, Sjöström A (2006) Accommodation and the relationship to subjective symptoms with near work for young school children. Ophthalmic Physiol Opt 26:148–155, doi:10.1111/j.1475–1313.2006.00364.x
Evans BJW (1998) The underachieving child. Ophthalmic Physiol Opt 18:153–159, doi:10.1016/S0275–5408(97)00068–9
Evans BJW, Patel R, Wilkins AJ, Lightstone A, Eperjesi F, Speedwell L et al (1999) A review of the management of 323 consecutive patients seen in a specific learning difficulties clinic. Ophthalmic Physiol Opt 19:454–466, doi:10.1046/j.1475–1313.1999.00465.x
Hennessey D, Iosue RA, Rouse MW (1984) Relation of symptoms to accommodative infacility of school-aged children. Am J Optom Physiol Opt 61:177–183
Kulp M, Schmidt P (1996) Visual predictors of reading performance in kindergarten and first grade children. Optom Vis Sci 73:255–262, doi:10.1097/00006324–199604000–00007
Hoffman L (1980) Incidence of vision dificulties in children with learning disabilities. J Am Optom Assoc 51:447–451
Helveston E, Weber J, Miller K, Robertson K, Hohberger G, Estes R et al (1985) Visual function and academic performance. Am J Ophthalmol 99:346–355
Blika S (1982) Ophthalmological findings in pupils of a primary school with particular reference to reading difficulties. Acta Ophthalmol (Copenh) 60:927–934
Kiely P, Crewther S, Crewther D (2001) Is there an association between functional vision and learning to read? Clin Exp Optom 84:346–353
Kedzia B, Tondel G, Pieczyrak D, Maples WC (1999) Accommodative facility test results and academic success in Polish second graders. J Am Optom Assoc 70:110–116
Latvala M, Korhonen T, Penttinen M, Laippala P (1994) Ophthalmic findings in dyslexic schoolchildren. Br J Ophthalmol 78:339–343, doi:10.1136/bjo.78.5.339
Hofstetter H (1944) A comparison of Duane’s and Donders tables of the amplitude of accommodation. Am J Optom Arch Am Acad Optom 21:345–363
Duane A (1912) Normal values of the accommodation at all ages. J Am Med Assoc 59:1010–1013
Kragha I (1986) Amplitude of accommodation:population and methodological differences. Ophthalmic Physiol Opt 6:75–80
Sterner B, Gellerstedt M, Sjöström A (2004) The amplitude of accommodation in 6– to 10-year-old children - not as good as expected!. Ophthalmic Physiol Opt 24:246–251, doi:10.1111/j.1475–1313.2004.00201.x
Jimenez R, Gonzalez MD, Perez MA, García JA (2003) Evolution of accommodative function and development of ocular movements in children. Ophthalmic Physiol Opt 23:97–107, doi:10.1046/j.1475–1313.2003.00093.x
Jackson TW, Goss D (1991) Variation and correlation of clinical tests of accommodative function in a sample of school-age children. J Am Optom Assoc 62:857–866
Goss D, Zhai H (1994) Clinical and laboratory investigations of the relationship of accommodation and convergence function with refractive error. Doc Ophthalmol 86:349–380, doi:10.1007/BF01204595
Scheiman M, Herzberg H, Frantz K, Margolies M (1988) Normative study of accommodative facility in elementary schoolchildren. Am J Optom Physiol Opt 65:127–134
Burge S (1979) Supression during binocular accommodative rock. Opt Mon 79:867–872
Motsch S, Mühlendyck H (2000) Frequency of reading disability caused by ocular problems in 9- and 10-year-old children in a small town. Strabismus 8:283–285, doi:10.1076/stra.8.4.283.689
Evans B, Drasdo N, Richards I (1994) Investigation of accommodative and binocular function in dyslexia. Ophthalmic Physiol Opt 14:5–19, doi:10.1111/j.1475–1313.1994.tb00550.x
Cuetos F, Rodriguez B, Ruano E (2000). Evaluación de los procesos lectores PROLEC (Madrid)
Ramos J, Cuetos F (1999). Evaluación de los procesos lectores PROLEC-SE (Madrid)
Scheiman M, Rouse M (1994) Optometric management of learning-related vision problems. Mosby, St. Louis
Scheiman M, Wick B (1994) Clinical management of binocular vision: Heterophoric, accommodative, and eye movement disorders. J.B. Lippincott Company, Philadelphia
Zellers JA, Alpert TL, Rouse MW (1984) A review of the literature and a normative study of accommodative facility. J Am Optom Assoc 55:31–37
Gwiazda J, Thom F, Bauer J, Held R (1993) Myopic children show insufficient accommodation response to blur. Invest Ophthalmol Vis Sci 34:690–694
Cacho P, García A, Lara F, Seguí MM (2002) Diagnostic signs of accommodative insufficiency. Optom Vis Sci 79:614–620, doi:10.1097/00006324–200209000–00013
Borsting E, Rouse MW, Deland PN, Hovett S, Kimura D, Park M et al (2003) Association of symptoms and convergence and accommodative insufficiency in school-age children. Optometry 74:25–34
Abdi S, Brautaset R, Rydberg A, Pansell T (2007) The influence of accommodative insufficiency on reading. Clin Exp Optom 90:36–43
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.
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). https://doi.org/10.1007/s00417-008-0921-5
- Accommodative function
- Poor readers
- School-age children
- Monocular accommodative amplitude
- Relative accommodation
- Binocular accommodative facility