|Title||ACCOMMODATIVE DYSFUNCTION POST-CONCUSSION IN THE ADOLESCENT POPULATION|
|Author, Co-Author||Aparna Raghuram, Sowjanya Gowrisankaran, Jameel Kanji, Ankoor Shah|
Aim: High incidence of binocular vision (BV) deficits involving vergence and accommodation has been reported post-concussion in the adolescent population. However, the nature of these deficits, particularly accommodative deficits, has not been well described. In this retrospective study, we report the clinical characteristics of accommodation deficits post-concussion.
Methods: 101 patient records were reviewed. Patients were seen at the multi-disciplinary clinic or referred to the optometry clinic at Boston Children’s Hospital between Dec, 2012 and Jan, 2016. All patients had 20/25 or better VA in each eye, had a full eye exam and BV assessment. The BV tests included push-up amplitude of accommodation (AA), monocular (MAF) and binocular (BAF) accommodative facility (+/-2.00), accommodative response (MEM), near point of convergence (NPC), fusional ranges and vergence facility.
Results: Of the 101 patients, 76 (75%) were diagnosed with accommodation deficit, of which 37 (49%) had an associated vergence deficit. The accommodation deficit was categorized as accommodative insufficiency (AI) if more than 2 criteria were satisfied: low AA (< age normal minus 2D), low MAF ( < = 6cpm) or BAF ( < 3 cpm) with minus lens difficulty; 11/76 patients had AI. None showed and accommodative excess (AE) profile. The remaining 65 patients, categorized as having accommodative dysfunction (AD), either had a low AA (19/65), low MAF (17/65) or both (29/65). Additionally, 40/46 patients with low MAF had difficulty clearing the plus lens. Of these 76 patients 27 also had convergence insufficiency and 11 had convergence excess. Although only 38/76 had an associated vergence deficits, interestingly significant number of these patients (67/76) had receded NPC, suggesting influence of blur.
Conclusion: AD, characterized by reduced MAF, particularly resulting from a difficulty to clear the plus lens, with or without low AA was commonly observed post-concussion in the adolescent population.
|Affiliation of Co-Authors||Boston Children's Hospital and Harvard Medical School, New England College of Optometry, Boston Children's Hospital and Harvard Medical School|