Accommodation and the relationship to subjective symptoms with near work for young school children.

The aim of this work was to study the relation between subjective symptoms at near and ocular accommodation in terms of the amplitude of accommodation and the relative accommodation. A secondary aim was to discuss the diagnosis of accommodative insufficiency. The chosen cohort was examined on two occasions with 1.8 years in between. The first examination included 72 children, 43 boys (mean age 8.1 years, ranging from 5.8 to 9.8) and 29 girls (mean age 8.3 years, ranging from 6.2 to 10.0). The second examination included 59 of these children, 34 boys (mean age 9.9 years, ranging from 7.8 to 11.7) and 25 girls (mean age 10.1 ranging from 8.0 to 11.8). Subjective symptoms at near work (headache, asthenopia, floating text, facility problems) were recorded and the amplitude and the relative accommodation, both positive and negative, were measured. The result from the questionnaire showed that at the first examination more than one-third of the children (34.7%) reported at least one subjective symptom when doing near work and 42.4% at the second examination. No symptoms were found among children younger than 7.5 years, but for children between 7.5 and 10 years old at the first examination, the prevalence of at least one symptom was 47.2%. At the second examination, symptoms were reported also for the youngest children, i.e. from the age of 8 years. The discrimination ability for the amplitude of accommodation, both monocular and binocular, was significant. In the first examination the difference between the mean for the two groups (i.e. with and without at least one symptom) was around 2.00 D monocular and 3.00 D binocular. Corresponding figures from the second examination was a difference between the mean for the two groups of around 3.50 D monocular and nearly 4.00 D binocular. We suggest that accommodation measurements should be performed more routinely and regularly, maybe as screening, especially in children over 8 years of age.