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A common condition experienced by adults and children is accommodative insufficiency where the individual's accommodation is less than expected for someone of their age.
They are (1) accommodative insufficiency (AI), the most common finding; (2) accommodative excess (AE) or pseudomyopia; and (3) dynamic accommodative infacility.
Abbreviations: AA = amplitude of accommodation, AE = accommodative excess, AI = accommodative insufficiency, AS/R = accommodative stimulus/response, CISS = Convergence Insufficiency Symptom Survey, cpm = cycles per minute, D = diopter, DoD = Department of Defense, FEF = frontal eye field, MRI = magnetic resonance imaging, mTBI = mild traumatic brain injury, NPA = near point of accommodation, NRA = negative relative accommodation, OD = right eye, OMT = oculomotor training, OS = left eye, P = placebo, pons = pontis, PRA = positive relative accommodation, SEM = standard error of mean, SD = standard deviation, SS = steady-state, SUNY = State University of New York, TBI = traumatic brain injury, VSAT = Visual Search and Attention Test.
Accommodative insufficiency was diagnosed when the lower limit of the expected value for the patient's age was abnormal according to Hofstetter's formula [18].
Of the patients who were unemployed (n = 4), 75 percent were diagnosed with accommodative insufficiency and/or convergence insufficiency, compared with only 33 percent of employed patients (n = 27).
The previous literature has revealed three types of accommodative dysfunctions in traumatic brain injury (TBI): accommodative insufficiency, pseudomyopia/ spasm of accommodation, and dynamic accommodative infacility.
Patients manifesting decreased accommodative amplitude are clinically diagnosed with accommodative insufficiency [6-7].
Accommodative insufficiency and fatigue are characterised by reduced amplitudes of accommodation in relation to the patient's age and signs of fatigue (further reduction of amplitude) on repeated testing.
Patients with ABI might present with accommodative insufficiency, accommodative fatigue, accommodative lag and accommodative infacility.
Indeed, it has been argued that accommodative insufficiency is the primary cause of symptoms in patients with convergence insufficiency.
If accommodative insufficiency or fatigue (Table 3) does not respond to eye exercises, or if the patient is not willing to do eye exercises, then the condition can be corrected with spectacles.
There are, of course, occasional cases where low plus lenses are indicated, for example cases of decompensated esophoria with a high AC/A ratio, or cases of accommodative insufficiency.