Impact of Visual Cues on the Magnitude and Variability of the Accommodative Response in Children With Emmetropia and Uncorrected Hyperopia and Adults

Purpose: We investigated the effect of blur and disparity cues on accommodative accuracy (lag) and variability (time [RMS] and frequency domain [LFC]) in the developing visual system. Methods: A total of 59 children (3-9 years, spherical equivalent refractive error [RE] = -0.3- +4.91 diopters [D]) and 10 adults (23-31 years, RE = -0.37-+1.15D) participated. Accommodation was measured in the right eye for 1 minute at 100 and 33 cm using photorefraction (25 Hz) for three conditions: blur + disparity (binocular, 20/50 optotypes), blur-only (monocular, 20/50 optotypes), disparity-only (binocular, difference-of-Gaussian stimulus). The effect blur and disparity cues have on accommodative accuracy, RMS, and LFC was assessed. Results: Lag, RMS, and LFC increased (P < 0.001) from 100 to 33 cm for each condition in children and adults. In children, accommodation was most accurate and stable when blur and disparity cues remained in the stimulus and became significantly less accurate and more variable (P < 0.001) when blur or disparity cues were removed at 33 cm. In adults, accommodation was significantly less accurate and more variable only when blur was removed from the stimulus (P < 0.022). Children with RE matched to adults had less accurate and more variable accommodative responses at near than adults when cues were removed (P ≤ 0.02). Conclusions: In children and adults, an increase in RMS and LFC is related to an increase in accommodative lag. Children's accommodative systems do not compensate as efficiently as adults when blur and disparity cues are removed, suggesting children <10 years old do not have a mature afferent visual pathway.