Received: 17 November 2021; Published on-line: 30 April 2022


Management of Accommodative Insufficiency among school-age children attending tertiary care Eye Institute

Dr. T. Suparna D. O. 1, FIPOS, Dr. Swaroopa Gudimetla M. S. 2, FIPOS

Sankar Foundation Eye Institute; Naiduthota, Visakhapatnam, Andhra Pradesh (India)

TO CITE THIS ARTICLE:Suparna T,  Swaroopa Gudimetla. Management of Accommodative Insufficiency among school-age children attending tertiary care Eye InstituteJ.ophthalmol.(Ukraine).2022;2:10-4.   http://doi.org/10.31288/oftalmolzh202221014


Introduction. Accommodative insufficiency (AI) is a non-strabismic binocular vision anomaly characterized by an inability to focus for near vision, with symptoms of blurred near vision, headache, visual fatigue, and asthenopic symptoms.

Purpose. To evaluate the efficacy of Plus Lens treatment, and Flipper glasses in the improvement of Accommodative Amplitude (AA) and Near Point of Accommodation (NPA) in Accommodative insufficiency (AI).

Methods. A prospective study of 50 children aged 8-15years with distance heterophoria (< 2 pd), near heterophoria(< 6 pd), Near Point of Convergence (NPC) (10 cm/better on Royal Air Force (RAF) rule), and NPA (worse than 10 cm, 15d – 2.5* age) were recruited during July 2018 to June 2019 and followed up for 3months. Measurements including NPC, NPA, and AA were measured in each eye of the Plus Lens Reading Addition(PLRA)  and Flipper group.

Results. Accommodative Insufficiency is higher in female children 67% in PLRA and 60% in the Flipper group with a mean age of 12.73 years in the PLRA group and 12.93 years in the Flipper group. NPA improved from 15.07 cm to 14.4 cm at 4 weeks, 11.87 cm at 8 weeks, and 9.33 cm at 12 weeks of treatment with PLRA. The NPA improved from 15.73 cm to 12.4 cm at 4 weeks, 10.93 cm at 8 weeks, and 8.27 cm at 12 weeks of treatment with Flipper glasses. AA improved from 6.73 D to 7.03 D at 4 weeks, 8.5 D at 8 weeks, and 10.73 D at 12 weeks of treatment with PLRA. The AA improved from 6.33 D to 8.03 D at 4 weeks, 9.13 D at 8 weeks, and 11.73 D at 12 weeks of treatment with Flipper glasses. Children reported good compliance and no longer experienced blur or headache.

Conclusion. A higher level of improvement in NPA and AA is observed in the Flipper group. Faster improvement is seen in the Flipper group, and treatment time needed will be shorter in the Flipper group, but it is more difficult to motivate subjects to do orthoptic exercises as compared to wearing reading glasses.

Кey words: accommodative dysfunction, flipper test, plus lens reading addition, vision therapy



AI: Accommodative insufficiency, AA:Accommodative Amplitude, BCVA:Best corrected visual acuity(BCVA), NPA:Near Point of Accommodation, NPC:Near Point of Convergence, PLRA:Plus Lens Reading Addition, RAF:Royal Air Force, D: diopters, pd: prism dioptres, Cm:centimeters .

Declaration of patient consent. The authors certify that they have obtained all appropriate patient consent forms from parents/guardians of the children. Ethics approval was obtained from the institutional ethics committee. 

Financial support and sponsorship. Nil. 

Conflicts of interest. There are no conflicts of interest.


1.Cooper J. Accommodative dysfunction. In Amos JF (Eds.), Diagnosis and management in vision care. Boston: Butterworths (1987): 431-459.

2.Scheiman M, Wick B. Clinical Management of Binocular Vision: Heterophoric, Accommodative and Eye Movement Disorders, 3rd ed. Philadelphia, PA: Lippincott, Williams and Wilkins; 2008.

3.Daum KM. Accommodative dysfunction. Doc Ophthalmol 1983; 55: 177-98.

Crossref  PubMed

4.Hennessey D, Iosue RA, Rouse MW. Relation of symptoms to accommodative infacility of school-aged children. Am J Optom Physiol Opt 1984; 61: 177-83.

Crossref  PubMed

5.Nunes AF, Monteiro PM, Ferreira FB, Nunes AS. Convergence insufficiency and accommodative insufficiency in children. BMC ophthalmology. 2019; 19 (1):1-8.

Crossref  PubMed

6.García-Muñoz Á, Carbonell-Bonete S, Cacho-Martínez P. Symptomatology associated with accommodative and binocular vision anomalies. Journal of Optometry. 2014; 7 (4): 178-92.

Crossref  PubMed

7.Wahlberg M, Abdi S, Brautaset R. Treatment of accommodative insufficiency with plus lens reading addition: is+ 1.00 D better than+ 2.00 D?. Strabismus. 2010 Jun 1;18(2):67-71.

Crossref  PubMed

8.Hussaindeen JR, Murali A. Accommodative Insufficiency: Prevalence, Impact and Treatment Options. Clinical Optometry. 2020;12:135.

Crossref  PubMed

9.Shukla Y. Accommodative anomalies in children. Indian Journal of Ophthalmology. 2020 Aug;68(8):1520.

Crossref  PubMed

10.Scheiman M, Cotter S, Kulp MT, Mitchell GL, Cooper J, Gallaway M, Hopkins KB, Bartuccio M, Chung I. Treatment of accommodative dysfunction in children: results from an random clinical trial. Optom Vis Sci 2011;88(11):1343.

Crossref  PubMed

11.Sterner B, Abrahamsson M, Sjostrom A. Accommodative facility training with a long term follow up in a sample of school aged children showing accommodative dysfunction. Doc Ophthalmol. 1999; 99: 93-101.

Crossref  PubMed

12.Daum KM. Accommodative insufficiency. Am J Optom Physiol Oрt. 1983; 60: 352-9.

Crossref  PubMed

13.Hoffman L, Cohen AH, Feuer G. Effectiveness of non – strabismus optometric vision training in a private practice. Am J Optom Arch Am Acad Optom.1973; 50: 813-6.

Crossref  PubMed

14.Rune Brautaset, Marika Wahlberg, Saber Abdi, Tony Pansell. Accommodation Insufficiency in children: Are Exercises better than Reading Glasses? Strabismus. 2008; 16: 65-69.

Crossref  PubMed

15.Abdi S, Rydberg A. Asthenopia in schoolchildren, orthoptic and ophthalmological findings and treatment. Doc Ophthalmol. 2005; 111(2): 65-72.

Crossref  PubMed

16.Scheiman M, Cotter S, Kulp MT, et al. Treatment of accommodative dysfunction in children: results from a randomized clinical trial. Optom Vis Sci. 2011; 88(11): 1343-1352.

Crossref  PubMed


Received 17.11.2021