Accommodative and Binocular Vision Testing in Young Myopic Children: Insights for Myopia Management and Best Clinical Practice

Accommodative and binocular vision (BV) function play a crucial role in the early assessment and management of myopia. This presentation explores a structured 2-system approach to diagnosing and managing accommodative and vergence anomalies in young myopic children. Objective methods, such as dynamic retinoscopy, are highlighted as more reliable than subjective techniques due to their ability to minimise overestimation of accommodative responses.

Key findings indicate that myopes exhibit greater accommodative lag, while emmetropes demonstrate superior binocular accommodative facility. Premyopes, identified by reduced hyperopic reserve for age, accommodative lag (>0.50D), and near esophoria/reduced exophoria (<4-6Δ), may be at a higher risk for myopia development. Additionally, accommodative insufficiency (AI) is frequently underdiagnosed in routine exams, despite its significant impact on visual efficiency and school performance.

Management strategies, including low-powered plus lenses (+0.75D to +1.00D), have been shown to effectively relieve symptoms of accommodative stress in children, with 98% reporting symptom improvement. Findings also suggest the importance of standardising accommodative testing in clinical practice to support accurate diagnosis and myopia management.

This talk emphasises the importance of integrating accommodative and BV assessments into myopia management strategies, using objective techniques where possible, and considering accommodative interventions in cases of binocular dysfunction.
 

Siofra Harrington