Age-related changes in static accommodation and accommodative miosis.

An attempt was made to explore the validity of the Hess-Gullstrand and Duane-Fincham models of presbyopia development, on the assumption that accommodative miosis could be used as an indicator of ciliary muscle effort. Monocular accommodation response and pupil size were measured as a function of accommodation demand over the range 0-4 D, in 48 normal subjects with ages between 17 and 56 years. The slope of the response/stimulus curve was found to decrease only slowly with age up to about 35 years and then to decline more rapidly. Accommodative miosis per dioptre of accommodation response did not change systematically with age up to about 35 years, this being apparently more in accord with the Hess-Gullstrand model. However, accommodative miosis varied very widely between younger subjects of similar age and accommodative amplitude (from zero to around 1 mm per dioptre of accommodation response for subjects in their twenties). It is concluded that miosis does not necessarily accompany accommodation and that its magnitude is not related in any simple general way to ciliary muscle contraction. Hence it cannot be used to support or refute particular theories of presbyopia.