The role of clinical diagnosis criteria on the frequency of accommodative insufficiency
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摘要
AIM: To estimate and compare the frequency of accommodative insufficiency(AI) within the same clinical population sample depending on the type of clinical criteria used for diagnosis. Comparing the frequency within the same population would help to minimize bias due to sampling or methodological variability. METHODS: Retrospective study of 205 medical records of symptomatic subjects free of any organic cause and symptoms persisting despite optical compensation evaluated. Based on the most commonly clinical diagnostics criteria found in the literature, four diagnostics criteria were established for AI(Ⅰ, Ⅱ, Ⅲ and Ⅳ) based on subjective accommodative tests: monocular accommodative amplitude two or more diopters below Hofstetter's minimum value [15-(0.25×age)](Ⅰ, Ⅱ, Ⅲ, Ⅳ); failing monocular accommodative facility with minus lens, establishing the cut-off in 0 cycles per minute(cpm)(Ⅰ) and in 6 cpm(Ⅱ, Ⅲ); failing binocular accommodative facility with minus lens, establishing the cut-off in 0 cpm(Ⅰ) and in 3 cpm(Ⅱ).RESULTS: The proportion of AI(95%CⅠ) for criteria Ⅰ, Ⅱ, Ⅲ and Ⅳ were 1.95%(0.04%-3.86%), 2.93%(0.31%-4.57%), 6.34%(1.90%-7.85%) and 41.95%(35.14%-48.76%) respectively, with a statistically significant difference shown between these values(χ2=226.7, P<0.001). A pairwise multiple comparison revealed that the proportion of AI detected for criterion Ⅳ was significantly greater than the proportion for the rest of the criteria(P-adjusted<0.05 in all cases).CONCLUSION: The prevalence of cases of AI within the same clinical population varies with the clinical diagnostic criteria selected. The variation is statistically significant when considering the monocular accommodative amplitude as the only clinical diagnostic sign.
AIM: To estimate and compare the frequency of accommodative insufficiency(AI) within the same clinical population sample depending on the type of clinical criteria used for diagnosis. Comparing the frequency within the same population would help to minimize bias due to sampling or methodological variability. METHODS: Retrospective study of 205 medical records of symptomatic subjects free of any organic cause and symptoms persisting despite optical compensation evaluated. Based on the most commonly clinical diagnostics criteria found in the literature, four diagnostics criteria were established for AI(Ⅰ, Ⅱ, Ⅲ and Ⅳ) based on subjective accommodative tests: monocular accommodative amplitude two or more diopters below Hofstetter's minimum value [15-(0.25×age)](Ⅰ, Ⅱ, Ⅲ, Ⅳ); failing monocular accommodative facility with minus lens, establishing the cut-off in 0 cycles per minute(cpm)(Ⅰ) and in 6 cpm(Ⅱ, Ⅲ); failing binocular accommodative facility with minus lens, establishing the cut-off in 0 cpm(Ⅰ) and in 3 cpm(Ⅱ).RESULTS: The proportion of AI(95%CⅠ) for criteria Ⅰ, Ⅱ, Ⅲ and Ⅳ were 1.95%(0.04%-3.86%), 2.93%(0.31%-4.57%), 6.34%(1.90%-7.85%) and 41.95%(35.14%-48.76%) respectively, with a statistically significant difference shown between these values(χ2=226.7, P<0.001). A pairwise multiple comparison revealed that the proportion of AI detected for criterion Ⅳ was significantly greater than the proportion for the rest of the criteria(P-adjusted<0.05 in all cases).CONCLUSION: The prevalence of cases of AI within the same clinical population varies with the clinical diagnostic criteria selected. The variation is statistically significant when considering the monocular accommodative amplitude as the only clinical diagnostic sign.
AIM: To estimate and compare the frequency of accommodative insufficiency(AI) within the same clinical population sample depending on the type of clinical criteria used for diagnosis. Comparing the frequency within the same population would help to minimize bias due to sampling or methodological variability. METHODS: Retrospective study of 205 medical records of symptomatic subjects free of any organic cause and symptoms persisting despite optical compensation evaluated. Based on the most commonly clinical diagnostics criteria found in the literature, four diagnostics criteria were established for AI(Ⅰ, Ⅱ, Ⅲ and Ⅳ) based on subjective accommodative tests: monocular accommodative amplitude two or more diopters below Hofstetter's minimum value [15-(0.25×age)](Ⅰ, Ⅱ, Ⅲ, Ⅳ); failing monocular accommodative facility with minus lens, establishing the cut-off in 0 cycles per minute(cpm)(Ⅰ) and in 6 cpm(Ⅱ, Ⅲ); failing binocular accommodative facility with minus lens, establishing the cut-off in 0 cpm(Ⅰ) and in 3 cpm(Ⅱ).RESULTS: The proportion of AI(95%CⅠ) for criteria Ⅰ, Ⅱ, Ⅲ and Ⅳ were 1.95%(0.04%-3.86%), 2.93%(0.31%-4.57%), 6.34%(1.90%-7.85%) and 41.95%(35.14%-48.76%) respectively, with a statistically significant difference shown between these values(χ2=226.7, P<0.001). A pairwise multiple comparison revealed that the proportion of AI detected for criterion Ⅳ was significantly greater than the proportion for the rest of the criteria(P-adjusted<0.05 in all cases).CONCLUSION: The prevalence of cases of AI within the same clinical population varies with the clinical diagnostic criteria selected. The variation is statistically significant when considering the monocular accommodative amplitude as the only clinical diagnostic sign.
引文
1 Duane A.Normal values of the accommodation at all ages.JAMA1912;LIX(12):1010-1013.
2 Hamasaki D,Ong J,Marg E.The amplitude of accommodation in presbyopia.Am J Optom Arch Am Acad Optom 1956;33(1):3-14.
3 Daum KM.Accommodative insufficiency.Am J Optom Physiol Opt1983;60(5):352-359.
4 Moore WD,Donders FC.On the influence of accommodation on the idea of distance.J Anat Physiol 1867;1(1):169-170.
5 Duane A.An attempt to determine the normal range of accommodation at various ages,being a revision of Donder’s experiments.Trans Am Ophthalmol Soc 1908;11(Pt 3):634-641.
6 Hofstetter W.A useful age-amplitude formula.Optom Vis Sci1947;24(4):202.
7 Daum RM.Clinical management of binocular vision:heterophoric,accommodative and eye movement disorders.Optom Vis Sci 1994;71(6):414.
8 Santaella RM,Fraunfelder FW.Ocular adverse effects associated with systemic medications:recognition and management.Drugs 2007;67(1):75-93.
9 Marran LF,De Land PN,Nguyen AL.Accommodative insufficiency is the primary source of symptoms in children diagnosed with convergence insufficiency.Optom Vis Sci 2006;83(5):281-289.
10 Anderson HA,Stuebing KK.Subjective versus objective accommodative amplitude:preschool to presbyopia.Optom Vis Sci 2014;91(11):1290-1301.
11 Antona B,Barra F,Barrio A,Gonzalez E,Sanchez I.Repeatability intraexaminer and agreement in amplitude of accommodation measurements.Graefes Arch Clin Exp Ophthalmol 2009;247(1):121-127.
12 Atchison DA,Capper EJ,Mc Cabe KL.Critical subjective measurement of amplitude of accommodation.Optom Vis Sci 1994;71(11):699-706.
13 Ostrin LA,Glasser A.Accommodation measurements in a prepresbyopic and presbyopic population.J Cataract Refract Surg2004;30(7):1435-1444.
14 Sheard C.In:Dynamic ocular test.The Shear volume Philadelphia:Chilton Company,1957;93-94.
15 Kragha IK.Amplitude of accommodation:population and methodological differences.Ophthalmic Physiol Opt 1986;6(1):75-80.
16 Momeni-Moghaddam H,Kundart J,Askarizadeh F.Comparing measurement techniques of accommodative amplitudes.Indian JOphthalmol 2014;62(6):683-687.
17 Scheiman M,Gallaway M,Coulter R,Reinstein F,Ciner E,Herzberg C,Parisi M.Prevalence of vision and ocular disease conditions in a clinical pediatric population.J Am Optom Assoc 1996;67(4):193-202.
18 Abdi S,Rydberg A.Asthenopia in schoolchildren,orthoptic and ophthalmological findings and treatment.Doc Ophthalmol 2005;111(2):65-72.
19 Cacho-Martínez P,García-Mu?ozá,Ruiz-Cantero MT.Do we really know the prevalence of accomodative and nonstrabismic binocular dysfunctions?J Optom 2010;3(4):185-197.
20 AlióJL,Radner W,Plaza-Puche AB,Ortiz D,Neipp MC,Quiles MJ,Rodríguez-Marín J.Design of short Spanish sentences for measuring reading performance:Radner-Vissum test.J Cataract Refract Surg2008;34(4):638-642.
21 Mc Clelland JF,Parkes J,Hill N,Jackson AJ,Saunders KJ.Accommodative dysfunction in children with cerebral palsy:a population-based study.Invest Ophthalmol Vis Sci 2006;47(5):1824-1830.
22 Leat SJ,Mohr A.Accommodative response in pre-presbyopes with visual impairment and its clinical implications.Invest Ophthalmol Vis Sci2007;48(8):3888-3896.
23 Leeflang MM,Rutjes AW,Reitsma JB,Hooft L,Bossuyt PM.Variation of a test’s sensitivity and specificity with disease prevalence.CMAJ 2013;185(11):E537-E544.
24 Sterner B,Gellerstedt M,Sj?str?m A.Accommodation and the relationship to subjective symptoms with near work for young school children.Ophthalmic Physiol Opt 2006;26(2):148-155.
25 Borsting E,Rouse MW,Deland PN,Hovett S,Kimura D,Park M,Stephens B.Association of symptoms and convergence and accommodative insufficiency in school-age children.Optometry 2003;74(1):25-34.
26 Dwyer P.The prevalence of vergence accommodation disorders in a school-age population.Clin Exp Optom 1992;75(1):10-18.
27 Abdi S,Rydberg A,Pansell T,Brautaset R.Evaluation of accommodative insufficiency with the visual analogue scale(VAS).Strabismus 2006;14(4):199-204.
28 Cacho P,García A,Lara F,SeguíMM.Diagnostic signs of accommodative insufficiency.Optom Vis Sci 2002;79(9):614-620.
29 Rouse MW,Borsting E,Hyman L,Hussein M,Cotter SA,Flynn M,Scheiman M,Gallaway M,de Land PN.Frequency of convergence insufficiency among fifth and sixth graders.The Convergence Insufficiency and Reading Study(CIRS)group.Optom Vis Sci 1999;76(9):643-649.
30 Porcar E,Martinez-Palomera A.Prevalence of general binocular dysfunctions in a population of university students.Optom Vis Sci1997;74(2):111-113.
31 Lara F,Cacho P,García A,Megías R.General binocular disorders:prevalence in a clinic population.Ophthalmic Physiol Opt 2001;21(1):70-74.
32 García A,Cacho P,Lara F.Evaluating relative accommodations in general binocular dysfunctions.Optom Vis Sci 2002;79(12):779-787.
33 Hoseini-Yazdi SH,Yekta A,Nouri H,Heravian J,Ostadimoghaddam H,Khabazkhoob M.Frequency of convergence and accommodative disorders in a clinical population of Mashhad,Iran.Strabismus2015;23(1):22-29.
34 Ansons AM,Davis H(2013)Refraction.In:Diagnosis and management of ocular motility disorders.John Wiley&Sons,2013:31-54.
35 Anderson HA,Glasser A,Stuebing KK,Manny RE.Minus lens stimulated accommodative lag as a function of age.Optom Vis Sci2009;86(6):685-694.
36 Wold JE,Hu AN,Chen S,Glasser A.Subjective and objective measurement of human accommodative amplitude.J Cataract Refract Surg 2003;29(10):1878-1888.
2 Hamasaki D,Ong J,Marg E.The amplitude of accommodation in presbyopia.Am J Optom Arch Am Acad Optom 1956;33(1):3-14.
3 Daum KM.Accommodative insufficiency.Am J Optom Physiol Opt1983;60(5):352-359.
4 Moore WD,Donders FC.On the influence of accommodation on the idea of distance.J Anat Physiol 1867;1(1):169-170.
5 Duane A.An attempt to determine the normal range of accommodation at various ages,being a revision of Donder’s experiments.Trans Am Ophthalmol Soc 1908;11(Pt 3):634-641.
6 Hofstetter W.A useful age-amplitude formula.Optom Vis Sci1947;24(4):202.
7 Daum RM.Clinical management of binocular vision:heterophoric,accommodative and eye movement disorders.Optom Vis Sci 1994;71(6):414.
8 Santaella RM,Fraunfelder FW.Ocular adverse effects associated with systemic medications:recognition and management.Drugs 2007;67(1):75-93.
9 Marran LF,De Land PN,Nguyen AL.Accommodative insufficiency is the primary source of symptoms in children diagnosed with convergence insufficiency.Optom Vis Sci 2006;83(5):281-289.
10 Anderson HA,Stuebing KK.Subjective versus objective accommodative amplitude:preschool to presbyopia.Optom Vis Sci 2014;91(11):1290-1301.
11 Antona B,Barra F,Barrio A,Gonzalez E,Sanchez I.Repeatability intraexaminer and agreement in amplitude of accommodation measurements.Graefes Arch Clin Exp Ophthalmol 2009;247(1):121-127.
12 Atchison DA,Capper EJ,Mc Cabe KL.Critical subjective measurement of amplitude of accommodation.Optom Vis Sci 1994;71(11):699-706.
13 Ostrin LA,Glasser A.Accommodation measurements in a prepresbyopic and presbyopic population.J Cataract Refract Surg2004;30(7):1435-1444.
14 Sheard C.In:Dynamic ocular test.The Shear volume Philadelphia:Chilton Company,1957;93-94.
15 Kragha IK.Amplitude of accommodation:population and methodological differences.Ophthalmic Physiol Opt 1986;6(1):75-80.
16 Momeni-Moghaddam H,Kundart J,Askarizadeh F.Comparing measurement techniques of accommodative amplitudes.Indian JOphthalmol 2014;62(6):683-687.
17 Scheiman M,Gallaway M,Coulter R,Reinstein F,Ciner E,Herzberg C,Parisi M.Prevalence of vision and ocular disease conditions in a clinical pediatric population.J Am Optom Assoc 1996;67(4):193-202.
18 Abdi S,Rydberg A.Asthenopia in schoolchildren,orthoptic and ophthalmological findings and treatment.Doc Ophthalmol 2005;111(2):65-72.
19 Cacho-Martínez P,García-Mu?ozá,Ruiz-Cantero MT.Do we really know the prevalence of accomodative and nonstrabismic binocular dysfunctions?J Optom 2010;3(4):185-197.
20 AlióJL,Radner W,Plaza-Puche AB,Ortiz D,Neipp MC,Quiles MJ,Rodríguez-Marín J.Design of short Spanish sentences for measuring reading performance:Radner-Vissum test.J Cataract Refract Surg2008;34(4):638-642.
21 Mc Clelland JF,Parkes J,Hill N,Jackson AJ,Saunders KJ.Accommodative dysfunction in children with cerebral palsy:a population-based study.Invest Ophthalmol Vis Sci 2006;47(5):1824-1830.
22 Leat SJ,Mohr A.Accommodative response in pre-presbyopes with visual impairment and its clinical implications.Invest Ophthalmol Vis Sci2007;48(8):3888-3896.
23 Leeflang MM,Rutjes AW,Reitsma JB,Hooft L,Bossuyt PM.Variation of a test’s sensitivity and specificity with disease prevalence.CMAJ 2013;185(11):E537-E544.
24 Sterner B,Gellerstedt M,Sj?str?m A.Accommodation and the relationship to subjective symptoms with near work for young school children.Ophthalmic Physiol Opt 2006;26(2):148-155.
25 Borsting E,Rouse MW,Deland PN,Hovett S,Kimura D,Park M,Stephens B.Association of symptoms and convergence and accommodative insufficiency in school-age children.Optometry 2003;74(1):25-34.
26 Dwyer P.The prevalence of vergence accommodation disorders in a school-age population.Clin Exp Optom 1992;75(1):10-18.
27 Abdi S,Rydberg A,Pansell T,Brautaset R.Evaluation of accommodative insufficiency with the visual analogue scale(VAS).Strabismus 2006;14(4):199-204.
28 Cacho P,García A,Lara F,SeguíMM.Diagnostic signs of accommodative insufficiency.Optom Vis Sci 2002;79(9):614-620.
29 Rouse MW,Borsting E,Hyman L,Hussein M,Cotter SA,Flynn M,Scheiman M,Gallaway M,de Land PN.Frequency of convergence insufficiency among fifth and sixth graders.The Convergence Insufficiency and Reading Study(CIRS)group.Optom Vis Sci 1999;76(9):643-649.
30 Porcar E,Martinez-Palomera A.Prevalence of general binocular dysfunctions in a population of university students.Optom Vis Sci1997;74(2):111-113.
31 Lara F,Cacho P,García A,Megías R.General binocular disorders:prevalence in a clinic population.Ophthalmic Physiol Opt 2001;21(1):70-74.
32 García A,Cacho P,Lara F.Evaluating relative accommodations in general binocular dysfunctions.Optom Vis Sci 2002;79(12):779-787.
33 Hoseini-Yazdi SH,Yekta A,Nouri H,Heravian J,Ostadimoghaddam H,Khabazkhoob M.Frequency of convergence and accommodative disorders in a clinical population of Mashhad,Iran.Strabismus2015;23(1):22-29.
34 Ansons AM,Davis H(2013)Refraction.In:Diagnosis and management of ocular motility disorders.John Wiley&Sons,2013:31-54.
35 Anderson HA,Glasser A,Stuebing KK,Manny RE.Minus lens stimulated accommodative lag as a function of age.Optom Vis Sci2009;86(6):685-694.
36 Wold JE,Hu AN,Chen S,Glasser A.Subjective and objective measurement of human accommodative amplitude.J Cataract Refract Surg 2003;29(10):1878-1888.