Chen Angela M, Borsting Eric J
Southern California College of Optometry, Marshall B Ketchum University, Fullerton, CA, USA.
Clin Exp Optom. 2023 Aug;106(6):675-680. doi: 10.1080/08164622.2022.2097002. Epub 2022 Jul 12.
Some children experience significant symptoms while doing near work, and accommodative deficits can be a contributory factor. However, studies investigating near work symptoms in children are sparse.
To investigate the association between clinical and objective measures of accommodation and near point symptoms.
Twelve asymptomatic and 14 symptomatic children (mean age = 11.1 and 11.8 years, respectively) based on their Convergence Insufficiency Symptom Survey scores participated in the study. The clinical measures of accommodation were monocular amplitude of accommodation, monocular accommodative facility, and monocular estimation method. Objective measurements of the accommodative stimulus response function were recorded with a WAM-5500 autorefractor for two consecutive minutes at five viewing distances (0.33, 2, 3, 4, and 5 Dioptres [D]). Accommodative findings were compared between the groups using the Mann-Whitney U-tests. Spearman's rank correlation coefficient was used to assess the association between symptoms and clinical and objective measures of accommodation.
The mean CISS scores were 32.8 and 7.3 for the symptomatic and asymptomatic groups, respectively (p = <0.001). The symptomatic group showed a reduced accommodative functions compared to the asymptomatic group (p = 0.002 for accommodative facility, p = 0.04 for accommodative amplitude, p = 0.029 and 0.01 for objective measures of accommodation at 4D and 5D viewing distance, respectively). Clinical tests of accommodative amplitude and facility (correlation coefficient = -0.407 and -0.54, respectively) showed the highest correlation with the CISS scores, compared to the objective measures of accommodation.
Clinical tests of accommodation showed a greater association with symptoms than objective measures of accommodation in children aged 8-16 years. In children presenting with visual discomfort symptoms, measurement of accommodative amplitude and facility should be considered.
一些儿童在进行近距离工作时会出现明显症状，调节功能不足可能是一个促成因素。然而，关于儿童近距离工作症状的研究较少。
探讨调节功能的临床和客观测量指标与近点症状之间的关联。
根据集合不足症状调查评分，12名无症状儿童和14名有症状儿童（平均年龄分别为11.1岁和11.8岁）参与了本研究。调节功能的临床测量指标包括单眼调节幅度、单眼调节灵活度和单眼估计法。使用WAM - 5500自动验光仪在五个视距（0.33、2、3、4和5屈光度[D]）下连续两分钟记录调节刺激反应函数的客观测量值。使用曼 - 惠特尼U检验比较两组之间的调节功能结果。采用斯皮尔曼等级相关系数评估症状与调节功能的临床和客观测量指标之间的关联。
有症状组和无症状组的平均CISS评分分别为32.8和7.3（p = <0.001）。与无症状组相比，有症状组的调节功能有所下降（调节灵活度p = 0.002，调节幅度p = 0.04，在4D和5D视距下调节功能的客观测量指标p分别为0.029和0.01）。与调节功能的客观测量指标相比，调节幅度和灵活度的临床测试（相关系数分别为 - 0.407和 - 0.54）与CISS评分的相关性最高。
在8 - 16岁儿童中，调节功能的临床测试与症状的关联比调节功能的客观测量更为密切。对于出现视觉不适症状的儿童，应考虑测量调节幅度和灵活度。
