Asymmetrical accommodation in hyperopic anisometropic amblyopia

Background/Aims: To investigate the presence of asymmetrical accommodation in hyperopic anisometropic amblyopia.

Methods: Accommodation in each eye and binocular vergence were measured simultaneously using a PlusoptiX SO4 photorefractor in 26 children aged 4 to 8 years with hyperopic anisometropic amblyopia and 13 controls (group age-matched) whilst they viewed a detailed target moving in depth.

Results: Without spectacles, only 5 (19%) of anisometropes demonstrated symmetrical accommodation (within the 95%CI of the mean gain of the sound eye of the anisometropic group), whereas 81% demonstrated asymmetrical accommodation. Of those, 15 (58%) showed aniso-accommodation and 6 (23%) demonstrated “anti-accommodation” (greater accommodation for distance than for near). In those with anti-accommodation the response gain in the sound eye was (0.93 ±0.20) whilst that of the amblyopic eye showed a negative accommodation gain of (-0.44 ±0.23). Anti-accommodation resolved with spectacles. Vergence gains were typical in those with symmetrical and asymmetrical accommodation.

Conclusion: The majority of hyperopic anisometropic amblyopes demonstrated nonconsensual asymmetrical accommodation. Approximately one in four demonstrated anti-accommodation.