Convergence and Accommodation Development Is Preprogrammed in Premature Infants.

PURPOSE: This study investigated whether vergence and accommodation development in preterm infants is preprogrammed or is driven by experience. METHODS: Thirty-two healthy infants, born at mean 34 weeks gestation (range, 31.2-36 weeks), were compared with 45 healthy full-term infants (mean 40.0 weeks) over a 6-month period, starting at 4 to 6 weeks postnatally. Simultaneous accommodation and convergence to a detailed target were measured using a Plusoptix PowerRefII infrared photorefractor as a target moved between 0.33 and 2 m. Stimulus/response gains and responses at 0.33 and 2 m were compared by both corrected (gestational) age and chronological (postnatal) age. RESULTS: When compared by their corrected age, preterm and full-term infants showed few significant differences in vergence and accommodation responses after 6 to 7 weeks of age. However, when compared by chronological age, preterm infants' responses were more variable, with significantly reduced vergence gains, reduced vergence response at 0.33 m, reduced accommodation gain, and increased accommodation at 2 m compared to full-term infants between 8 and 13 weeks after birth. CONCLUSIONS: When matched by corrected age, vergence and accommodation in preterm infants show few differences from full-term infants' responses. Maturation appears preprogrammed and is not advanced by visual experience. Longer periods of immature visual responses might leave preterm infants more at risk of development of oculomotor deficits such as strabismus.

Change in convergence and accommodation after two weeks of eye exercises in typical young adults.

BACKGROUND: Although eye exercises appear to help heterophoria, convergence insufficiency, and intermittent strabismus, results can be confounded by placebo, practice, and encouragement effects. This study assessed objective changes in vergence and accommodation responses in naive young adults after a 2-week period of eye exercises under controlled conditions to determine the extent to which treatment effects occur over other factors. METHODS: Asymptomatic young adults were randomly assigned to one of two no-treatment (control) groups or to one of six eye exercise groups: accommodation, vergence, both, convergence in excess of accommodation, accommodation in excess of convergence, and placebo. Subjects were tested and retested under identical conditions, except for the second control group, who were additionally encouraged. Objective accommodation and vergence were assessed to a range of targets moving in depth containing combinations of blur, disparity, and proximity/looming cues. RESULTS: A total of 156 subjects were included. Response gain improved more for less naturalistic targets where more improvement was possible. Convergence exercises improved vergence for near across all targets (P = 0.035). Mean accommodation changed similarly but nonsignificantly. No other treatment group differed significantly from the nonencouraged control group, whereas encouraging effort produced significantly increased vergence (P = 0.004) and accommodation (P = 0.005) gains in the second control group. CONCLUSIONS: True treatment effects were small, significantly better only after vergence exercises to a nonaccommodative target, and rarely related to the response they were designed to improve. Exercising accommodation without convergence made no difference to accommodation to cues containing detail. Additional effort improved objective responses the most.

Blink frequency and duration during perimetry and their relationship to test-retest threshold variability.

PURPOSE: To describe different patterns of blinking in patients undergoing a visual field test and to establish whether the blink parameters are related to threshold variability. METHODS: Thirty-nine patients with diagnosed or suspected glaucoma were recruited to undertake a perimetric task twice. Blinks were detected with a video eye-tracker system that records at a sampling rate of 60 Hz. Blink frequency, duration, and episodes of microsleep (eye closures >500 ms) were analyzed, and correlated with test-retest threshold variability. The timing of blinks with respect to stimulus presentation was analyzed and the percentage of seen stimuli for all presentations (POS(overall)) and those overlapped with blinks (POS(overlapped)) were compared. RESULTS: Blink frequency ranged from 0 to 58 per minute. A significant increase in blink frequency was observed in the second test (P < 0.001), whereas blink duration and microsleep episodes were not significantly different between the two tests. The relationship between test-retest threshold variability and all blink parameters was not significant. For suprathreshold stimulus presentations, blinks often occurred after presentation, whereas for subthreshold presentations, their timing was independent of stimulus timing. The difference between POS(overall) and POS(overlapped) was significant (P < 0.001), and a slight decrease in POS(overlapped) was observed with the increase of overlap duration. CONCLUSIONS: A wide range of blink frequencies was observed during perimetric testing. Although no blink parameters showed significant influence on threshold variability, when the blinks overlapped with a stimulus presentation, the probability of seeing was reduced. For suprathreshold stimuli, blinks often occurred after the presentation, whereas for subthreshold presentations, there was no relationship to presentation time.