<p>Accommodative Insufficiency: Prevalence, Impact and Treatment Options</p>

Abstract

Purpose Accommodative insufficiency (AI), defined as the inability to stimulate accommodation in pre-presbyopic individuals, has gained much attention over recent years. Despite the enormity of the available information, there is a significant lack of clarity regarding the criteria for definition, methodology adopted for testing and diagnosis, and the varied prevalence across the globe. This review aims to gather evidence that is pertinent to the prevalence, impact and efficacy of available treatment options for AI. Methods PubMed, Google Scholar and Cochrane Collaboration search engines were used with the keywords prevalence, accommodative insufficiency, symptoms, plus lens, vision therapy and treatment. Peer-reviewed articles published between 1992 and 2019 were included in the review. After reviewing the studies for study methodology and robustness, 83 articles were chosen for this literature review. Results The prevalence of AI ranges between <1.00% and 61.6% across studies. The prevalence shows considerable variation across ethnicities and age groups. There is significant variation in the study methodology, diagnostic criteria and number of tests performed to arrive at the diagnosis. Not many studies have explored the prevalence beyond 20 years of age. The prevalence of AI is high among children with special needs. There is no high-quality evidence regarding the standard treatment protocol for AI. Both vision therapy and low plus lenses have shown efficacy in independent studies, and no studies have compared these two treatment options. Conclusion The understanding of AI prevalence is currently limited owing to the lack of a standard set of diagnostic criteria and wide variations in the study methodology. There is a lack of high-quality evidence suggesting the best possible treatment for AI. The current gaps in the literature have been identified and future scope for exploration is elucidated.

Strabismus, stereoacuity, accommodation and convergence in young adults born premature and screened for retinopathy of prematurity

“…In contrast to our findings, Lindqvist et al did not find a difference in accommodation in low-birthweight adolescents compared with controls (Lindqvist et al 2008). Accommodative insufficiency can have various aetiologies, among them neurological deficits (Almog 2008;Hussaindeen & Murali 2020). However, in this population, there was a difference between preterms and controls, even after the exclusion of the preterms with a neurological complication at 2.5 years of age.…”

“…2008). Accommodative insufficiency can have various aetiologies, among them neurological deficits (Almog 2008; Hussaindeen & Murali 2020). However, in this population, there was a difference between preterms and controls, even after the exclusion of the preterms with a neurological complication at 2.5 years of age.…”

Binocular vision findings in normally-sighted school aged children who used digital devices

“…The constant change of focus from the digital screen to their required homework copies needs good accommodative system. Prevalence of accommodative insufficiency as high as our findings is alarming to the caretakers of the children at school and at home [ 37 ].…”

Refractive error, accommodation and lens opacification in adults born preterm and full‐term: Results from the Gutenberg Prematurity Eye Study (GPES)

“…This finding is in congruence to previous reports of individuals born preterm in childhood (Larsson et al 2012) and young adulthood (P etursd ottir et al 2021a) while Lindqvist et al (Lindqvist et al 2008) did not observe differences in accommodation in participants with low birth weight in adolescence. Previous authors speculated that low accommodation amplitudes can have multiple origins, such as a consequence of neurological deficits (Almog 2008;Hussaindeen & Murali 2020). Since we did not exclude participants with neurologic complications, we cannot rule out that these contributed to the low accommodation amplitude in the ROP treated participants.…”