Citation:García-Montero M,Antona B,Barrio AR,Nieto-Zayas C,Martínez-Alberquilla I,Hernández-Verdejo JL.The role of clinical diagnosis criteria on the frequency of accommodative insufficiency.Int J Ophthalmol 2019;12(4):647-653,doi:10.18240/ijo.2019.04.20
The role of clinical diagnosis criteria on the frequency of accommodative insufficiency
Received:April 04, 2018  Revised:October 11, 2018
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DOI:10.18240/ijo.2019.04.20
Key Words:epidemiology  amplitude of accommodation  accommodative facility
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María García-Montero Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid 28037, Spain
Beatriz Antona Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid 28037, Spain
Ana Rosa Barrio Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid 28037, Spain
Carmen Nieto-Zayas Department of Statistics and Operations Research III, Faculty of Statistical Studies, Complutense University of Madrid, Madrid 28040, Spain
Irene Martínez-Alberquilla Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid 28037, Spain
José Luis Hernández-Verdejo Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, Madrid 28037, Spain
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Abstract:
      AIM: To estimate and compare the frequency of accommodative insufficiency (AI) within the same clinical population sample depending on the type of clinical criteria used for diagnosis. Comparing the frequency within the same population would help to minimize bias due to sampling or methodological variability.

    METHODS: Retrospective study of 205 medical records of symptomatic subjects free of any organic cause and symptoms persisting despite optical compensation evaluated. Based on the most commonly clinical diagnostics criteria found in the literature, four diagnostics criteria were established for AI (I, II, III and IV) based on subjective accommodative tests: monocular accommodative amplitude two or more diopters below Hofstetter’s minimum value [15-(0.25×age)] (I, II, III, IV); failing monocular accommodative facility with minus lens, establishing the cut-off in 0 cycles per minute (cpm) (I) and in 6 cpm (II, III); failing binocular accommodative facility with minus lens, establishing the cut-off in 0 cpm (I) and in 3 cpm (II).

    RESULTS: The proportion of AI (95%CI) for criteria I, II, III and IV were 1.95% (0.04%-3.86%), 2.93% (0.31%-4.57%), 6.34% (1.90%-7.85%) and 41.95% (35.14%-48.76%) respectively, with a statistically significant difference shown between these values (χ2=226.7, P<0.001). A pairwise multiple comparison revealed that the proportion of AI detected for criterion IV was significantly greater than the proportion for the rest of the criteria (P-adjusted<0.05 in all cases).

    CONCLUSION: The prevalence of cases of AI within the same clinical population varies with the clinical diagnostic criteria selected. The variation is statistically significant when considering the monocular accommodative amplitude as the only clinical diagnostic sign.

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