J.ophthalmol.(Ukraine).2020;5:21-28.
http://doi.org/10.31288/oftalmolzh202052128
Received: 05 August 2020; Published on-line: 27 October 2020
Pupil response to accommodation and convergence in children and adolescents with accommodative disorders
Shakir Dukhayer, N. M. Bushuieva, S. B. Slobodianyk
SI "The Filatov Institute of Eye Diseases and Tissue Therapy of the NAMS of Ukraine; Odesa (Ukraine)
E-mail: bushuyevan@gmail.com
TO CITE THIS ARTICLE:Dukhayer Shakir, Bushuieva NM, Slobodianyk SB. Pupil response to accommodation and convergence in children and adolescents with accommodative disorders. J.ophthalmol.(Ukraine).2020;5:21-8. http://doi.org/10.31288/oftalmolzh202052128
Background: As there is close association between pupil response and accommodation during gaze fixation on an object at any distance, it seems interesting to study pupil response to accommodation in patients with accommodative disorders.
Purpose: To assess pupil response to accommodation and convergence in children and adolescents with accommodative disorders who varied in age and autonomic nervous system (ANS) tone.
Material and Methods: One hundred and thirty children and adolescents (260 eyes) having accommodation spasm (AS) and 59 (118 eyes) having accommodative insufficiency (AI) were included in the study. They underwent measurements of best-corrected visual acuity, refractive errors, and axial length, and assessment of accommodation reserve (by the technique of Dashevsky) and body’s autonomic nervous system (ANS) balance (by Kerdo index). Pupillography studies were performed using an OK-2 pupillographer (Ukraine) to assess pupil area, amplitude of change in pupil area, and durations of phases of changes in pupil area.
Results: An increased parasympathetic tone was more common among 6-14-year-old children with AS than among age-matched healthy children (64.5% vs 29-43%), and the rest of these cases had an increased sympathetic tone. The mean maximum pupil area Smax value for children with AS and increased sympathetic tone was 27.5 ± 4.1 mm2, which was 25.6% greater than for those with AS and increased parasympathetic tone (21.9 ± 5.6 mm2, p < 0.001), and 102% less than for healthy children with increased sympathetic tone (55.6 ± 13.5 mm2, p < 0.001). In addition, pupil constriction latency (Phase II) and active pupil constriction (Phase III) were longer for patients than for controls. Among children and adolescents with AS, pupil parameters significantly depended on the ANS tone, but not on the age. This was different from healthy children, in whom pupil area parameters correlated both with age and with ANS tone, whereas durations of changes in pupil area (i.e., phases III, V and VI) were correlated only with age. All children with AI had an increased sympathetic tone. Compared to healthy children with an increased sympathetic tone, children with AI demonstrated smaller Smax and longer pupil re-dilation latency (Phase V) (p < 0.05). There was no significant difference in other pupil characteristics between patients of the study and healthy individuals. We found a substantial difference in Smax between children with AS (23.94±5.5 mm2) and those with AI (49.3 ± 13.8 mm2).
Conclusion: Children with AS develop some imbalance of the body’s and ocular autonomic nervous systems with a shift towards an increased parasympathetic activity. The relationships developed between pupil responses, age and state of autonomic innervation in children with AS are different from those in healthy children, with the tone of the ANS, but not age playing a major role. We found a substantial difference in Smax between children with AS and those with AI, which may be considered along with clinical signs and body’s ANS tone as differential diagnostic criteria for accommodative disorder and facilitate a pathogenesis-oriented treatment approach.
Keywords: accommodation spasm, accommodative insufficiency, pupillography, pupil response to accommodation and convergence, children and adolescents, autonomic nervous system
References
1.Von Noorden GK, Campos EC. Binocular Vision and Ocular Motility. Theory and management of strabismus. 6th ed. St. Louis, MO: Mosby; 2001.
2.Katargina LA, editor. [Accommodation: A guide for physicians]. Moscow: Aprel; 2012. Russian.
3.Miller NR, Newman NJ, Biousse V, Kerrison JB. Walsh & Hoyt’s Clinical Neuro-ophthalmology. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005.
4.Dukhayer Shakir, Bushuieva NM, Slobodianyk SB. Pupil response to accommodation and convergence in healthy children and adolescents of various age groups and autonomic nervous system tone. J Ophthalmol (Ukraine). 2020;2:37-45.
5.Emslie R., Claassens А., Sachs N., Walters I. The near triad and associated visual problems. S Afr Optom. 2007; 66(4): 184-191.
6.Vein AM, editor. [Autonomic nervous system abnormalities: Clinical signs, diagnosis and treatment]. Moscow: Meditsinskoe informatsionnoe agenstvo; 2003. Russian.
7.Bushuieva NM, Boychuk IM, Dukhayer Shakir, Khramenko NI, Ponomarchuk VS. [Method of computer pupillography]. Ukrainskyi medychnyi almanakh. 2006;9(2):24-7. Ukrainian.
8.Bushuieva NM, Boychuk IM, Khramenko NI. [Method for diagnosing disorders of accommodation based on pupillographic studies of pupillary response]. Arkhiv klinicheskoi i eksperimentalnoi meditsiny. 2001;10(2);132-3. Russian.
9.Glanz S. [Biomedical statistics]. Moscow: Praktika;1998. Russian.
10.Zaitsev VM, Lifliandskii VG, Maeinkin VI. [Tutorial in applied medical statistics]. St Peterburg:Foliant;2008. Russian.
11.Volkova EM. [Effect of accommodative nervous system tone on accommodation function in myopia]. Abstract of Cand Sc (Med) Thesis. Yaroslavl: Yaroslavl State Medical Academy; 2007. Russian.
12.Prediger VM. [Clinical, functional and neurophysiological assessment of children with acquired myopia]. Abstract of Cand Sc (Med) Thesis. Novosibirsk: Novosibirsk State Medical University; 2017. Russian.
The authors certify that they have no conflicts of interest in the subject matter or materials discussed in this manuscript.