Understanding accommodative control in the clinic: Modeling latency and amplitude for uncorrected refractive error, presbyopia and cycloplegia.

Accommodation is the process of adjusting the eye's optical power so as to focus at different distances. Uncorrected refractive error and/or functional presbyopia mean that sharp focus may not be achievable for some distances, so observers experience sustained defocus. Here, we identify a problem with current models of accommodative control: They predict excessive internal responses to stimuli outside accommodative range, leading to unrealistic adaptation effects. Specifically, after prolonged exposure to stimuli outside range, current models predict long latencies in the accommodative response to stimuli within range, as well as unrealistic dynamics and amplitudes of accommodative vergence innervation driven by the accommodative neural controller. These behaviors are not observed empirically. To solve this issue, we propose that the input to blur-driven accommodation is not retinal defocus, but correctable defocus. Predictive models of accommodative control already estimate demand from sensed defocus, using a realistic "virtual plant" to estimate accommodation. Correctable defocus can be obtained by restricting this demand to values physically attainable by the eye. If we further postulate that correctable defocus is computed using an idealized virtual plant that retains a young accommodative range, we can explain why accommodative-convergence responses are observed for stimuli that are too near-but not too far-to focus on. We model cycloplegia as a change in gain, and postulate a form of neural myopia to explain the additional relaxation of accommodation often seen with cycloplegia. This model produces plausible predictions for the accommodative response and accommodative convergence signal in a wide range of clinically relevant situations.

Success rates, near-response patterns, and learning trends with free-fusion stereograms.

Free-fusion stereograms are routinely used for demonstrating various stereoscopic effects. Yet, untrained observers find it challenging to perform this task. This study showed that only less than 1/3rd of sixty-one pre-presbyopic adults with normal binocular vision could successfully free-fuse random-dot image pairs and identify the stereoscopic shapes embedded in these patterns. Another one-third of participants performed the task with poor success rates, while the remaining could not perform the task. There was a clear dissociation of vergence and accommodative responses in participants who were successful with free-fusion, as recorded using a dynamic infrared eye tracker and photorefractor. Those in the unsuccessful cluster either showed strong vergence and accommodation or weak vergence and strong accommodation during the task. These response patterns, however, were specific to the free-fusion task because all these participants generated good convergence/accommodation to real-world targets and to conflicting vergence and accommodative demands stimulated with prisms or lenses. Task performance of the unsuccessful cluster also improved significantly following pharmacological paralysis of accommodation and reached the performance levels of the successful cluster. A minority of participants also appeared to progressively learn to dissociate one of the two directions of their vergence and accommodation crosslinks with repeated free-fusion trials. These results suggest that successful free-fusion might depend upon how well participants generate a combination of volitional and reflex vergence responses to large differences in disparity with conflicting static accommodative demands. Such responses would require that only one direction of the vergence-accommodation crosslinks be active at any given time. The sequence of near-responses could also be learnt through repeated trials to optimize task performance.

Seeing the future: Predictive control in neural models of ocular accommodation.

Ocular accommodation is the process of adjusting the eye's crystalline lens so as to bring the retinal image into sharp focus. The major stimulus to accommodation is therefore retinal defocus, and in essence, the job of accommodative control is to send a signal to the ciliary muscle which will minimize the magnitude of defocus. In this article, we first provide a tutorial introduction to control theory to aid vision scientists without this background. We then present a unified model of accommodative control that explains properties of the accommodative response for a wide range of accommodative stimuli. Following previous work, we conclude that most aspects of accommodation are well explained by dual integral control, with a "fast" or "phasic" integrator enabling response to rapid changes in demand, which hands over control to a "slow" or "tonic" integrator which maintains the response to steady demand. Control is complicated by the sensorimotor latencies within the system, which delay both information about defocus and the accommodation changes made in response, and by the sluggish response of the motor plant. These can be overcome by incorporating a Smith predictor, whereby the system predicts the delayed sensory consequences of its own motor actions. For the first time, we show that critically-damped dual integral control with a Smith predictor accounts for adaptation effects as well as for the gain and phase for sinusoidal oscillations in demand. In addition, we propose a novel proportional-control signal to account for the power spectrum of accommodative microfluctuations during steady fixation, which may be important in hunting for optimal focus, and for the nonlinear resonance observed for low-amplitude, high-frequency input. Complete Matlab/Simulink code implementing the model is provided at https://doi.org/10.25405/data.ncl.14945550.

A computational analysis of retinal image quality in eyes with keratoconus.

Higher-order aberrations (HOA's) are exaggerated in eyes with keratoconus but little is known about their impact on the retinal image quality (IQ) of these eyes. This computational study determined changes in IQ [peak IQ, best focus and depth of focus (DOF)] of 12 subjects with manifest keratoconus in both eyes (KCE cohort), 9 subjects with very asymmetric ectasia (VAE cohort) with and without their Rigid Gas Permeable contact lenses (RGP CL's) and 20 age-matched controls, using a HOA-based through-focus analysis performed on the logNS IQ metric over 5 mm pupil diameter following cycloplegia. All IQ parameters were significantly worse in the KCE cohort with their native HOA's, relative to controls and in the ectatic eye of the VAE cohort, relative to the fellow non-ectatic eye (p ≤ 0.008 for all). Reduction in HOA's of these eyes with RGP CL's resulted in a significant improvement in all IQ parameters but they all remained significantly poorer than controls (p ≤ 0.02 for all). The inter-subject variability of best focus and the DOF range were inversely related to peak IQ in these eyes (r = 0.85; p < 0.001). These results provide the optical basis for two clinical observations on keratoconus: (1) optical performance of keratoconic eyes are significantly better with RGP CL's than with spectacles or unaided conditions and (2) the endpoint of subjective refraction is elusive in keratoconic eyes, relative to healthy controls or to the non-ectatic eye in bilaterally asymmetric ectasia.

Binocular cross-correlation analyses of the effects of high-order aberrations on the stereoacuity of eyes with keratoconus.

Stereoacuity losses are induced by increased magnitudes and interocular differences in high-order aberrations (HOAs). This study used keratoconus as a model to investigate the impact of HOAs on disparity processing and stereoacuity. HOAs and stereoacuity were quantified in subjects with keratoconus (n = 21) with HOAs uncorrected (wearing spectacles) or minimized (wearing rigid gas-permeable contact lenses) and in control subjects without keratoconus (n = 5) for 6-mm pupil diameters. Disparity signal quality was estimated using metrics derived from binocular cross-correlation functions of stereo pairs convolved with point-spread functions from these HOAs. Metrics computed for all subjects were compared with stereoacuities. The effects of contrast losses and phase shifts on disparity signal quality were studied independently by manipulating the amplitude and phase components of optical transfer functions. The magnitudes, orientations, interocular relationships in magnitude, and shape of the point-spread function affected the cross-correlation metrics that determine disparity signal quality. Stereoacuity covaries strongly with cross-correlation metrics and moderately with image-quality metrics. Both phase distortions and contrast losses due to HOAs significantly influence computations of binocular disparity. HOA-induced stereoacuity reductions are attributable to disparity blur and noise from image properties that reduce the height and kurtosis of the peak stimulus disparity match of the cross-correlation. Phase distortions and contrast losses due to HOAs are both partly responsible for the greater stereoacuity losses seen with spectacles compared to rigid gas-permeable contact lenses in keratoconus.

LogMAR and Stereoacuity in Keratoconus Corrected with Spectacles and Rigid Gas-permeable Contact Lenses.

SIGNIFICANCE: This study showed an improvement in three-dimensional depth perception of subjects with bilateral and unilateral keratoconus with rigid gas-permeable (RGP) contact lens wear, relative to spectacles. This novel information will aid clinicians to consider RGP contact lenses as a management modality in keratoconic patients complaining of depth-related difficulties with their spectacles. PURPOSE: The aim of this study was to systematically compare changes in logMAR acuity and stereoacuity from best-corrected spherocylindrical spectacles to RGP contact lenses in bilateral and unilateral keratoconus vis-à-vis age-matched control subjects. METHODS: Monocular and binocular logMAR acuity and random-dot stereoacuity were determined in subjects with bilateral (n = 30; 18 to 24 years) and unilateral (n = 10; 18 to 24 years) keratoconus and 20 control subjects using standard psychophysical protocols. RESULTS: Median (25th to 75th interquartile range) monocular (right eye) and binocular logMAR acuity and stereoacuity improved significantly from spectacles to RGP contact lenses in the bilateral keratoconus cohort (P < .001). Only monocular logMAR acuity of affected eye and stereoacuity improved from spectacles to RGP contact lenses in the unilateral keratoconus cohort (P < .001). There was no significant change in the binocular logMAR acuity from spectacles to RGP contact lenses in the unilateral keratoconus cohort. The magnitude of improvement in binocular logMAR acuity and stereoacuity was also greater for the bilateral compared with the unilateral keratoconus cohort. All outcome measures of cases with RGP contact lenses remained poorer than control subjects (P < .001). CONCLUSIONS: Binocular resolution and stereoacuity improve from spectacles to RGP contact lenses in bilateral keratoconus, whereas only stereoacuity improves from spectacles to RGP contact lenses in unilateral keratoconus. The magnitude of improvement in visual performance is greater for the binocular compared with the unilateral keratoconus cohort.

Envisioning Eye Care From a Rural Perspective: A Photovoice Project From India.

Background To understand barriers and promoters for accessing eye care by rural communities, we used a modified approach to Photovoice, a community-based participatory action research approach Methods Community members took photographs and wrote or spoke stories based upon a series of questions intended to facilitate deeper thinking. Fifteen rural paramedical team members who were affiliated with the rural network of L V Prasad Eye Institute, and 60 people from four villages reported barriers and promoters for eye care access for 20 villages Results Important barriers for accessing eye care included the following: no caretaker at home for grandchildren except for the grandparent(s), alcoholism, uncontrolled blood pressure, inadequate diabetes management, lack of escort for blind people and elders, affordability, and inadequate clinic staffing during summer season when farming villagers were available. Important promoters for seeking eye care included having a neighbor who had a good surgical outcome in one eye which resulted in the ability to resume work. The Photovoice project offered specific suggestions to hospital management for improving eye care access, including providing evening transportation, providing additional surgical staffing during busy summer season, and the creation of tool spectacle repair kits to be kept at the primary vision centers Conclusions This Photovoice project facilitated a deeper understanding of the important barriers and promoters for accessing eye care by villagers, and by the rural eye care team, offering specific suggestions to hospital management for improving eye care access and to communicate without any inhibiting factors like fear of hierarchy within the hospital administration.

Potential role for microfluctuations as a temporal directional cue to accommodation.

The goal was to revisit an important, yet unproven notion that accommodative microfluctuations facilitate the determination of direction (sign) of abrupt focus changes in the stimulus to accommodation. We contaminated the potential temporal cues from natural accommodative microfluctuations by presenting uncorrelated external (screen) temporal defocus noise that combined with the retinal image effects of natural microfluctuations. A polychromatic Maltese spoke pattern thus either modulated defocus at a combination of two temporal frequencies (on-screen noise condition) or was static (control condition). The on-screen conditions were combined with step changes in optical vergence that were randomized in direction and magnitude. Five subjects monocularly viewed stimuli through a Badal optical system in a Maxwellian view. An artificial 4-mm aperture was imaged at the entrance pupil of the eye. Wavefront aberrations were measured dynamically at 50 Hz using a custom Shack-Hartmann aberrometer. Dynamic changes in the Zernike defocus term with step changes in optical vergence were analyzed. We calculated the percentage of correct directional responses for 1, 2, and 3 D accommodative and disaccommodative step stimuli using preset criteria for latency, velocity, and persistence of the response. The on-screen noise condition reduced the percent-correct responses compared to the static stimulus, suggesting that this manipulation affected the detectability of the sign of the accommodative stimulus. Several possible reasons and implications of this result are discussed.

Saccadic latency in amblyopia.

We measured saccadic latencies in a large sample (total n = 459) of individuals with amblyopia or risk factors for amblyopia, e.g., strabismus or anisometropia, and normal control subjects. We presented an easily visible target randomly to the left or right, 3.5° from fixation. The interocular difference in saccadic latency is highly correlated with the interocular difference in LogMAR (Snellen) acuity-as the acuity difference increases, so does the latency difference. Strabismic and strabismic-anisometropic amblyopes have, on average, a larger difference between their eyes in LogMAR acuity than anisometropic amblyopes and thus their interocular latency difference is, on average, significantly larger than anisometropic amblyopes. Despite its relation to LogMAR acuity, the longer latency in strabismic amblyopes cannot be attributed either to poor resolution or to reduced contrast sensitivity, because their interocular differences in grating acuity and in contrast sensitivity are roughly the same as for anisometropic amblyopes. The correlation between LogMAR acuity and saccadic latency arises because of the confluence of two separable effects in the strabismic amblyopic eye-poor letter recognition impairs LogMAR acuity while an intrinsic sluggishness delays reaction time. We speculate that the frequent microsaccades and the accompanying attentional shifts, made while strabismic amblyopes struggle to maintain fixation with their amblyopic eyes, result in all types of reactions being irreducibly delayed.

The impact of higher-order aberrations on the strength of directional signals produced by accommodative microfluctuations.

It has been proposed that the accommodation system could perform contrast discrimination between the two dioptric extremes of accommodative microfluctuations to extract directional signals for reflex accommodation. Higher-order aberrations (HOAs) may have a significant influence on the strength of these contrast signals. Our goal was to compute the effect HOAs may have on contrast signals for stimuli within the upper defocus limit by comparing computed microcontrast fluctuations with psychophysical contrast increment thresholds (Bradley & Ohzawa, 1986). Wavefront aberrations were measured while subjects viewed a Maltese spoke stimulus monocularly. Computations were performed for accommodation or disaccommodation stimuli from a 3 Diopter (D) baseline. Microfluctuations were estimated from the standard deviation of the wavefronts over time at baseline. Through-focus Modulation Transfer, optical contrast increments (ΔC), and Weber fractions (ΔC/C) were derived from point spread functions computed from the wavefronts at baseline for 2 and 4 cycles per degree (cpd) components, with and without HOAs. The ΔCs thus computed from the wavefronts were compared with psychophysical contrast increment threshold data. Microfluctuations are potentially useful for extracting directional information for defocus values within 3 D, where contrast increments for the 2 or 4 cpd components exceed psychophysical thresholds. HOAs largely reduce contrast signals produced by microfluctuations, depending on the mean focus error, and their magnitude in individual subjects, and they may shrink the effective stimulus range for reflex accommodation. The upper defocus limit could therefore be constrained by discrimination of microcontrast fluctuations.

The effect of perceptual grouping on perisaccadic spatial distortions.

Perisaccadic spatial distortion (PSD) occurs when a target is flashed immediately before the onset of a saccade and it appears displaced in the direction of the saccade. In previous studies, the magnitude of PSD of a single target was affected by multiple experimental parameters, such as the target's luminance and its position relative to the central fixation target. Here we describe a contextual effect in which the magnitude of the PSD for a target was influenced by the synchronous presentation of another target: PSD for simultaneously presented targets was more uniform than when each was presented individually. Perisaccadic compression was ruled out as a causal factor, and the results suggest that both low- and high-level perceptual grouping mechanisms may account for the change in PSD magnitude. We speculate that perceptual grouping could play a key role in preserving shape constancy during saccadic eye movements.

Short-term adaptation of accommodation, accommodative vergence and disparity vergence facility.

Previous studies have found that subjects can increase the velocity of accommodation using visual exercises such as pencil push ups, flippers, Brock strings and the like and myriad papers have shown improvement in accommodation facility (speed) and sufficiency (amplitude) using subjective tests following vision training but few have objectively measured accommodation before and after training in either normal subjects or in patients diagnosed with accommodative infacility (abnormally slow dynamics). Accommodation is driven either directly by blur or indirectly by way of neural crosslinks from the vergence system. Until now, no study has objectively measured both accommodation and accommodative-vergence before and after vision training and the role vergence might play in modifying the speed of accommodation. In the present study, accommodation and accommodative-vergence were measured with a Purkinje Eye Tracker/optometer before and after normal subjects trained in a flipper-like task in which the stimulus stepped between 0 and 2.5 diopters and back for over 200 cycles. Most subjects increased their speed of accommodation as well as their speed of accommodative vergence. Accommodative vergence led the accommodation response by approximately 77 ms before training and 100 ms after training and the vergence lead was most prominent in subjects with high accommodation and vergence velocities and the vergence leads tended to increase in conjunction with increases in accommodation velocity. We surmise that volitional vergence may help increase accommodation velocity by way of vergence-accommodation cross links.

Does ethnicity influence the short-term adaptation to first reading correction?

PURPOSE: Ethnic variations in accommodative amplitude (AA) are not uncommon. Accommodation can become reduced in response to short-term wear of first near spectacles. Whether ethnicity has an influence on the magnitude of this adaptation is not well understood. We investigated the impact of first near spectacles on changes in AA and on convergence cross-link interactions in incipient presbyopes of Chinese and Caucasian ethnicities. METHODS: Forty-one subjects (22 Caucasians and 19 Chinese) aged 36 to 44 years completed the study. Accommodative stimulus response function, AA, and AC/A and CA/C ratios were measured before and after single vision reading spectacles were used for near tasks over a 2-month period and then again 2 months after discontinuing near spectacle wear. RESULTS: After wearing reading spectacles for 2 months, the accommodative stimulus response slopes and AC/A and CA/C ratios remained invariant irrespective of ethnicity. The accommodative, but not vergence, bias decreased (p < 0.05). The nearpoint of accommodation shifted distally producing an average decrease in AA of 0.52 D from baseline (p < 0.05). Recovery to near baseline values occurred after discontinuing the reading glasses for 2 months. Differences based on ethnicity were not significant. The baseline AA vs. age plots showed steeper slopes for Chinese than the Caucasian subjects in the sample. CONCLUSIONS: The pattern of adaptation by accommodation and cross-link interactions to short-term first reading spectacles is not influenced by ethnicity.

Effects of accommodation training on accommodation and depth of focus in an eye implanted with a crystalens intraocular lens.

PURPOSE: To investigate objective measures of the effects of accommodative training of a pseudophakic eye implanted with a Crystalens AT-52SE (eyeonics Inc) intraocular lens (IOL) on reading performance, accommodation, and depth of focus. METHODS: Objective dynamic measures of accommodation, pupil size, and depth of focus were quantified from wavefront measures before and after 1 week of accommodative training that began 29 months after implantation of an accommodating IOL in one patient. Depth of focus was estimated from 50% cut-off of peak performance levels for defocus curves that were computed from the image quality metric VSOTF based on ocular wavefront aberrations. RESULTS: The patient reported improved near vision reading performance after completing the training procedure. After training, there was a shift in conjugate focus in the hyperopic direction, yet the depth of focus increased significantly for near objects. Simulated retinal images and the calculated modulation transfer function of the eye both demonstrated improved quality for near vision after training. CONCLUSIONS: The subjective report of improved near vision after training was correlated with improvement of objective measures. Depth of focus increased for near objects with attempts to accommodate after training. This change was linked to increases in aberrations and pupil size and occurred despite the conjugate focus shifting in the hyperopic direction. These results demonstrate that accommodative training may be useful in improving near vision in patients with accommodating IOLs.

Perisaccadic stereo depth with zero retinal disparity.

When an object is viewed binocularly, unequal perspective projections of the two eyes' half images (binocular disparity) provide a cue for the sensation of stereo depth. For almost 200 years, binocular disparity has remained synonymous with retinal disparity, which is computed by subtracting the distance of each half image from its respective fovea. However, binocular disparity could also be coded in headcentric instead of retinal coordinates, by combining eye position and retinal image position in each eye and representing disparity as differences between visual directions of half images relative to the head. Although these two disparity-coding schemes suggest very different neural mechanisms, both offer identical predictions for stereopsis in almost every viewing condition, making it difficult to empirically distinguish between them. We designed a novel stimulus that uses perisaccadic spatial distortion to generate inconsistency between headcentric and retinal disparity. Foveal half images flashed asynchronously just before a horizontal saccade have zero retinal disparity, yet they produce a sensation of depth consistent with a nonzero headcentric disparity. Furthermore, this headcentric disparity can cancel and reverse the perceived depth stimulated with nonzero retinal disparity. This is the first demonstration that a coding scheme other than retinal disparity has a role in human stereopsis.

The first and second order dynamics of accommodative convergence and disparity convergence.

Main sequences, the function describing the relationship between eye movement amplitude and velocity, have been used extensively in oculomotor research as an indicator of first-order dynamics yet it is difficult to find main sequence analyses for accommodative vergence or for disparity vergence in isolation when all mitigating factors have been well controlled and there are no studies in which accommodative vergence and disparity vergence main sequences have been generated for the same group of subjects. The present study measured main sequences in: (1) accommodative vergence with disparity vergence open loop, (2) disparity vergence with accommodation open loop, and (3) combinations of accommodative and disparity vergence. A dynamic AC/A ratio was defined and was found to be similar to the traditional static AC/A ratio. Vergence acceleration was measured for all conditions. A pulse-step model of accommodation and convergence was constructed to interpret the dynamics of the crosslinked interactions between the two systems. The model supports cross-coupling of both the pulse and step components and simulates the primary empirical findings that: (1) disparity vergence has a higher main sequence slope than accommodative vergence, (2) both accommodative and disparity vergence acceleration increase with response amplitude whereas accommodation acceleration does not.

Charles F. Prentice award lecture 2008: surgical correction of presbyopia with intraocular lenses designed to accommodate.

Surgical restoration of accommodation with accommodating intra-ocular lenses (A-IOLs) presents a complex set of problems involving the design of the prosthetic mechanism. A variety of designs are currently employed that either translate the A-IOL toward the cornea along the sagittal axis, shear two lens components laterally, or deform lens shape to change dioptric power of the eye during attempts to accommodate. Effective biomechanical properties (elasticity and viscosity) of these lenses depend on both material properties and structural design of the A-IOL. Inevitable mismatches between the neuromuscular control of accommodation and the effective biomechanical properties of the prosthetic lens could lead to either unstable oscillations or sluggishness of dynamic accommodation; however, optimal dynamic responses may possibly be restored by neural recalibration. A model of dynamic accommodation is used to predict the consequences of these mismatches on dynamic accommodation, and reverse engineering is used to test the feasibility of neuromuscular recalibration. Empirical measures verify that neuromuscular adaptation of dynamic accommodation is possible in response to optically simulated increases and decreases of ocular-lens stiffness. Other design issues for A-IOLs include stability of optical properties, aberrations and image quality, and interactions of restored accommodation with binocular eye alignment (the near response).

Neuromuscular plasticity and rehabilitation of the ocular near response.

The near response is composed of cross-coupled interactions between convergence and other distance-related oculomotor responses including accommodation, vertical vergence, and cyclovergence. The cross-coupling interactions are analogous to the body postural reflexes that maintain balance. Near-response couplings guide involuntary motor responses during voluntary shifts of distance and direction of gaze without feedback from defocus or retinal-image disparity. They optimize the disparity stimulus for stereoscopic depth perception and can be modified by optically induced sensory demands placed on binocular vision. In natural viewing conditions, the near response is determined by passive orbital mechanics and active-adaptable tonic components. For example, the normal coupling of vertical vergence with convergence in tertiary gaze is partly a byproduct of passive orbital mechanics. Both, adapted changes of vertical vergence in response to anisophoria, produced by unequal ocular magnification (aniseikonia), and adapted changes in the orientation of Listing's plane in response to torsional disparities can be achieved by a combination of passive orbital mechanics and neural adjustments for the control of the vertical vergence and cyclovergence. Adaptive adjustments are coupled with gaze direction, convergence angle, and head tilt. Several adaptation studies suggest that it is possible to achieve non-linear changes in the coupling of both vertical vergence and cyclovergence with gaze direction. This coupling can be achieved with changes in neural control signals of ocular elevator muscles that are cross-coupled with both convergence and direction of tertiary gaze. These linear and non-linear coupling interactions can be adapted to compensate for (1) anisophoria induced by spectacle corrections for anisometropia, (2) accommodative esotropia, (3) convergence excess and insufficiency, and (4) non-concomitant deviations with ocular torticollis associated with trochlear palsy. The adaptable near-response couplings form the basis of an area of orthoptics that optimizes visual performance by facilitating our natural ability to calibrate neural pathways underlying binocular postural reflexes.

The influence of first near-spectacle reading correction on accommodation and its interaction with convergence.

PURPOSE: Accommodation and convergence can adapt to blur and disparity stimuli and to age-related changes in accommodative amplitude. Does this ability decline with age? The authors investigated short-term adaptation to first near-spectacle reading correction on the accommodative-stimulus response (ASR) function, accommodative amplitude (AA), AC/A, and CA/C ratios in a pre-presbyopic and an incipient presbyopic population and determined whether changes in these functions recovered after discontinuation of the use of near spectacles. METHODS: Thirty subjects with normal vision participated; their ages ranged from 21 to 30 years (n = 15) and 38 to 44 years (n = 15). Oculomotor functions were measured before and after single-vision reading spectacles were worn for near tasks over a 2-month period and then 2 months after the use of near spectacles was discontinued. RESULTS: The slope of the ASR function and the AC/A and CA/C ratios did not change significantly after near spectacles were worn. There was a hyperopic shift of the ASR function that significantly reduced the near point of accommodation (NPA) and lowered the far-point refraction. These changes were age invariant and did not recover after 2 months of discontinuation of near spectacle wear. CONCLUSIONS: These results imply that the NPA may be enhanced normally by tonic bias of accommodation that elevates the entire ASR function and produces myopic refraction bias. When this bias relaxes after reading spectacles are worn, there is a hyperopic shift of the refractive state and a reduction of the NPA, specified from optical infinity.

Short-term adaptive modification of dynamic ocular accommodation.

PURPOSE: Indirect observations suggest that the neural control of accommodation may undergo adaptive recalibration in response to age-related biomechanical changes in the accommodative system. However, there has been no direct demonstration of such an adaptive capability. This investigation was conducted to demonstrate short-term adaptation of accommodative step response dynamics to optically induced changes in neuromuscular demands. METHODS: Repetitive changes in accommodative effort were induced in 15 subjects (18-34 years) with a double-step adaptation paradigm wherein an initial 2-D step change in blur was followed 350 ms later by either a 2-D step increase in blur (increasing-step paradigm) or a 1.75-D step decrease in blur (decreasing-step paradigm). Peak velocity, peak acceleration, and latency of 2-D single-step test responses were assessed before and after 1.5 hours of training with these paradigms. RESULTS: Peak velocity and peak acceleration of 2-D step responses increased after adaptation to the increasing-step paradigm (9/12 subjects), and they decreased after adaptation to the decreasing-step paradigm (4/9 subjects). Adaptive changes in peak velocity and peak acceleration generalized to responses that were smaller (1 D) and larger (3 D) than the 2-D adaptation stimulus. The magnitude of adaptation correlated poorly with the subject's age, but it was significantly negatively correlated with the preadaptation dynamics. Response latency decreased after adaptation, irrespective of the direction of adaptation. CONCLUSIONS: Short-term adaptive changes in accommodative step response dynamics could be induced, at least in some of our subjects between 18 and 34 years, with a directional bias toward increasing rather than decreasing the dynamics.