Aboumourad Rami, Anderson Heather A
College of Optometry, University of Houston, Houston, Texas.
Optom Vis Sci. 2019 Sep;96(9):670-677. doi: 10.1097/OPX.0000000000001423.
This study promotes the use of dynamic retinoscopy to obtain objective measures of accommodative amplitude (AA) in the clinical setting in lieu of the subjective push-up technique.
This study compared the agreement between open-field autorefraction and a modified dynamic retinoscopy for the objective measurement of AA.
Accommodative amplitude was measured using two objective techniques for subjects aged 5 to 60 years. Test order was randomized and monocular AA was measured as subjects viewed printed letters 0.9 mm in height with their dominant eye and distance refraction. For retinoscopy, subjects held a near rod and viewed the target at the nearest (most proximal) point of clear vision. The examiner then performed dynamic retinoscopy along the horizontal meridian and identified the physical location of neutrality of the reflex, which was converted to AA in diopters. Autorefraction was performed obtaining repeated measures of refraction beginning from a target demand of 2.5 D and increasing in discrete steps until there was no subsequent increase in accommodative response. Refractions were converted to power in the horizontal meridian and expressed as accommodation in diopters with the maximal value termed the AA. Distance overrefractions were measured for both techniques to adjust AA for any uncorrected refractive error. Difference versus mean analysis was used to compare agreement between tests.
The 95% limits of agreement between techniques were calculated after removal of two young outliers who responded poorly to one of the techniques. The overall mean difference for 95 subjects was 0.02 ± 0.97 D, with limits of agreement spanning -1.87 to 1.92 D. No significant linear relationship between the magnitude of the AA and the differences between techniques was observed.
Agreement between dynamic retinoscopy and open-field autorefraction was less than 2 D with no systematic bias, suggesting that dynamic retinoscopy may be a suitable clinical technique to measure objective AA.
本研究推动了在临床环境中使用动态检影法来获取调节幅度（AA）的客观测量值，以替代主观的上推法。
本研究比较了开放视野自动验光与改良动态检影法在客观测量AA方面的一致性。
使用两种客观技术对5至60岁的受试者测量调节幅度。测试顺序随机，当受试者用优势眼观看高度为0.9毫米的印刷字母并进行远距验光时，测量单眼AA。对于检影法，受试者手持近用杆并在最清晰视觉的最近（最靠近）点观看目标。然后检查者沿水平子午线进行动态检影，并确定反射中性的物理位置，将其转换为屈光度的AA。进行自动验光，从2.5 D的目标需求开始，以离散步骤增加，直至调节反应不再增加，从而获得重复的验光测量值。将验光结果转换为水平子午线的屈光度，并表示为屈光度的调节，最大值称为AA。对两种技术都测量了远距复验，以针对任何未矫正的屈光不正调整AA。使用差异与均值分析来比较测试之间的一致性。
在剔除对其中一种技术反应不佳的两名年轻异常值后，计算了两种技术之间的95%一致性界限。95名受试者的总体平均差异为0.02±0.97 D，一致性界限范围为-1.87至1.92 D。未观察到AA大小与技术之间差异的显著线性关系。
动态检影法与开放视野自动验光之间的一致性小于2 D，且无系统偏差，这表明动态检影法可能是测量客观AA的合适临床技术。
