Dynamic accommodation and myopia.

PURPOSE: Accommodative effort during nearwork is thought to be a causative factor in the development of myopia. It has been proposed that an anomaly in autonomic control may be a precursor to the development of myopia. In the present study the closed-loop accommodation response after variations in fixation period was investigated in emmetropes, early-onset myopes and late-onset myopes to determine characteristics of reflex accommodation for each refractive group. METHODS: Closed-loop accommodation responses were measured in a group of emmetropes (n = 7), early-onset myopes (n = 7), and late-onset myopes (n = 7) by use of a dynamic tracking infrared optometer. A variation in fixation period (10 seconds, 60 seconds, and 180 seconds) before an accommodative step was used to stimulate the accommodation control mechanism differentially. RESULTS: Group results of accommodative response times showed that late-onset myopes were significantly affected by the duration of fixation before the change in stimulus vergence. Accommodative response times after 3 minutes of sustained near vision were significantly longer than those observed for other groups for the near-to-far condition. Reaction time appears to be independent of refractive grouping, prior fixation period, and direction of step change. CONCLUSIONS: Late-onset myopes showed significantly extended accommodation response times after a sustained near vision task that was demonstrable under well-controlled experimental conditions. The extended response times observed in the present study were consistent with previous reports of refractive shifts in late-onset myopes and early-onset myopes and provide a corollary between reflex and adaptive components of the accommodation response. Potential mechanisms are discussed in an attempt to explain the resultant hysteresis under closed-loop viewing conditions.

Human dynamic closed-loop accommodation augmented by sympathetic inhibition.

PURPOSE: A ciliary alpha-adrenoceptor accommodative effect has been proposed, caused by a small population of alpha1-inhibitory receptors in excised human ciliary muscle. This study was intended to investigate the effect on the closed-loop dynamic accommodative process of modulating alpha1-adrenoceptor activity by topical instillation of the alpha1-adrenergic agonist, phenylephrine hydrochloride. METHODS: A group of 10 visually normal subjects viewed a photopic (30 candela/m2) high-contrast Maltese cross, which was modulated sinusoidally (0.05-0.6Hz) and stepwise over a 2-D range (2-4 D). Monocular temporal accommodation responses were measured using a continuously recording dynamic tracking infrared optometer under two trial conditions: after instillation of saline control solution and 50 minutes subsequent to the instillation of 0.27 microl 0.4% benoxinate hydrochloride and 0.27 microl 2.5% phenylephrine hydrochloride. Pupil size and accommodative amplitude were measured at 90-second intervals for 50 minutes after drug instillation. All accommodative measurements were recorded through a fixed 4-mm pupil. RESULTS: A significant reduction in accommodative amplitude (11%; P < 0.05) was recorded, whereas pupil size showed a significant increase (33%; P < 0.05). No significant change in step-response dynamics was observed. However, phenylephrine hydrochloride caused a significant increase in accommodative gain in the low and midtemporal frequency ranges compared with the effect of a saline control treatment. No significant variation in phase lag was observed. CONCLUSIONS: For the first time in humans, this study shows that augmentation of the alpha1-inhibitory sympathetic contribution results in increased accommodative gain at low and midtemporal frequencies, which is consistent with findings in animal studies.