Accommodative Dysfunction is the medical term used to describe when a person has difficulty with their focusing system, unrelated to natural aging changes. Accommodation occurs by movement of the lens inside the eye. This movement is controlled by muscles that generally relax to see far away and contract to see clearly at near. This mechanism is separate from “refractive error” or the need for glasses at distance; however, uncorrected refractive error can influence this system.
Accommodative ability is generally well developed by 4 months of age and should continue to work efficiently until around age 40, when the lens begins to become less flexible and therefore harder to move. This is why the majority of older adults require reading glasses or bifocals as they get older.
There are generally three types of accommodative dysfunctions:
- Accommodative Insufficiency- difficulty efficiently sustaining focus at near. This is the most common type of accommodative dysfunction. The increased effort required to maintain clear vision at near can decrease performance on near tasks.
- Accommodative Infacility- difficulty efficiently switching focus between near and far and back
- Accommodative Spasm- a spasm of the focusing muscle which prevents the focusing muscles from fully relaxing. This generally causes blurry vision both near and far.
Physical Symptoms of Accommodative Dysfunctions
- Blurred vision at near
- Intermittent blurred vision at distance after reading
- Difficulty switching between near and far
- Eye strain
- Headaches- especially over the brow or temples
- Eye fatigue
- General fatigue, especially later in the day
- Symptoms often are worse when tired, later in the day or during tasks
Behavioral Symptoms of Accommodative Dysfunctions
- Avoidance of detailed near work (usually reading/writing, sometimes math)
- Difficulty sustaining attention, especially on near work
- Difficulty with copying from the board
- Holding material too close
- Requires frequent breaks to complete work
- Makes frequent mistakes, poor attention to details
- Poor reading fluency or comprehension
Treatment may include the prescribing of special lenses to help reduce eye strain at near and/or optometric vision therapy. Over-the-counter reading glasses are made for adults and are generally not advised for children, as they can create new problems. At our clinic, treatment of accommodative dysfunctions with optometric vision therapy has a very high success rate (greater than 90%) and often requires between 12 to 24 sessions, when combined with home support activities. Patients with additional visual diagnoses, autism, developmental delay or a history of traumatic brain injury/concussion may require a longer treatment plan.
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