Case Of Poor Maintenance Of Accommodation

Case Study

The patient, a 13-year-old female, had ghosting during close reading and had difficulty remembering what she had read. The patient had no obvious organic lesions in the eyes, no obvious systemic diseases and medication history. The inspection results are as follows:
Far naked vision: OD: 0.3, OS: 0.4
Near naked vision: OD: 0.4, OS: 0.5
Refractive inspection: OD: - 4.50ds / - 0.50DC * 180 → 1.0, OS:-4.50DS→1.0

The initial measurement and adjustment functions are normal. Ask the patient to recheck the visual function after reading for 15 minutes. The results are as follows:
Near Point Convergence: 5cm           
Far Eye Position Inspection: 4 △ exophoria           
Near Eye Position Inspection: normal           
Near Negative Convergence And Divergence: 15 △ / 20 △ / 13 △           
Near Positive Convergence And Divergence: 20 △ / 22 △ / 18 △,  AC/A:3△/D
Amplitude Of Accommodation: (Push-up): OD: 7D, OS: 7D
NRA:+2.50D   PRA:-1.00D
Accommodation Reaction(MEM Dynamic Retinoscopy): OD: + 1.00D, OS: + 1.00D
Accommodation Facility: OD: 8 c / min, OS: 8 c / min, and the negative photometric direction is delayed significantly.

Analysis:
The far and near eye position of the patient is normal, and the convergence and divergence function is basically normal, indicating that it is not convergence and divergence dysfunction. Through additional measurement after close reading for 15 minutes, it is found that the age is 13 years old, and the minimum amplitude of accommodation should be about 12D. The accommodation amplitude of this patient is lower than the lowest value of the same age, PRA is lower than the normal value, the accommodation facility is reduced, and the accommodation reaction lags behind. It can be diagnosed that this patient has poor accommodation maintenance.