Rehabilitation treatment of a patient with symptoms of computer visual syndrome and concomitant asthenic form of accommodative asthenopia in an asthenic-neurotic state of psychosomatic genesis is discussed. The treatment was based on an integrated approach that takes into account diagnostic criteria (the volume of absolute accommodation, indicators of objective accommodation, the severity of asthenopia, the state of psychological adaptation) and the basic principles of medical and rehabilitation measures, including, along with traditional methods of correcting asthenic-neurotic states, sequential and staged physiotherapeutic and optical-reflex effects on the accommodative system of the eye.

Aim: to assess the prevalence and clinical functional features of asthenic accommodative asthenopia in patients with computer vision syndrome.Patients and Methods: 86 men (172 eyes) aged 24–36 years (mean age 28.6±1.4 years) were examined. Major inclusion criteria were occupational daily activities (at least 2 years) regarded as a visually intensive work related to electronic chart displays (at least 8 hours daily) with a high level of responsibility for a final result; complaints which are typical of accommodative asthenopia and evident of its subcompensation or decompensation; low myopia (SE <3.0 diopters) or emmetropia; no ocular disorders (excepting refractive errors).Results: the analysis of basic diagnostic criteria demonstrated that habitually excessive accommodation strain (HEAS) was diagnosed in 51 patients (59.3%) and asthenic accommodative asthenopia in 19 patients (22.1%). In 16 patients (18.6%), the parameters did not meet the criteria of the investigated types of asthenopia. The most typical accommodative disorders in asthenic accommodative asthenopia are the significant reduction of accomodogram growth parameters and the high-frequency component of accommodative microfluctuations. The reasons for these phenomena are asthenization and weak ciliary muscle. Additionally, patients with asthenic accommodative asthenopia were characterized by the lowest score of the quality of visual life and subjective psychophysiological status compared to HEAS patients and controls. Conclusion: asthenic accommodative asthenopia is characterized by specific clinical functional and diagnostic criteria identified by both conventional and modern methods of the examination of visual accommodative system. These criteria can be recommended to assess the efficacy of preventive and therapeutic measures.Keywords: asthenopia, computer vision syndrome, accommodation, objective accommodography.For citation: Ovechkin I.G., Gadzhiev I.S., Kozhukhov A.A., Belikova E.I. Diagnostic criteria for asthenic accommodative asthenopia in patients with computer vision syndrome. Russian Journal of Clinical Ophthalmology. 2020;20(4):169–174. DOI: 10.32364/2311-7729-2020-20-4-169-174.

Optical-reflex treatment of patients with myopia and computer visual syndrome with a concomitant asthenic form of accommodation asthenopia seems relevant and not fully developed. The basic provisions that determine the tactics of treatment are monocular exposure in order to increase the absolute accommodation rate and staging (outpatient room, home conditions) of training. Measures aimed at improving the effectiveness of optical reflex treatment at home include the development of alternative instrumentation with reasonable (in accordance with the clinical and physiological characteristics of the functioning of the ciliary muscle of the eye) optical, amplitude and temporal parameters of the training process.