The Relationship between the High-Frequency Component of Accommodative Microfluctuation, Accommodative Lag and Accommodative Amplitude in Presbyopic Eyes

Lock Hyun Ju; Dong Ho Lee; Do Hyung Lee; Jin Hyoung Kim

doi:10.3341/jkos.2014.55.11.1606

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Ju, Lee, Lee, and Kim: The Relationship between the High-Frequency Component of Accommodative Microfluctuation, Accommodative Lag and Accommodative Amplitude in Presbyopic Eyes

Original Article

J Korean Ophthalmol Soc 2014;55(11):1606-1612.

Published online: 2 September 2014

DOI: https://doi.org/10.3341/jkos.2014.55.11.1606

The Relationship between the High-Frequency Component of Accommodative Microfluctuation, Accommodative Lag and Accommodative Amplitude in Presbyopic Eyes

Lock Hyun Ju, MD¹, Dong Ho Lee, MD², Do Hyung Lee, MD, PhD¹, Jin Hyoung Kim, MD, PhD¹

¹Department of Ophthalmology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea

²Bit-Sarang Eye Hospital, Seoul, Korea

Address reprint requests to Jin Hyoung Kim, MD, PhD, Department of Ophthalmology, Inje University Ilsan Paik Hospital, #170 Juhwa-ro, Ilsanseo-gu, Goyang 411-706, Korea, Tel: 82-31-910-7240, Fax: 82-31-911-7241, E-mail: jhk0924@hanmail.net

Received 31 May 2014 Revised 6 August 2014 Accepted 16 October 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To determine the relationship between the high-frequency component of accommodative microfluctuation (HFC) and accommodative lag in presbyopic eyes and how they affect the subjective accommodation power with other ophthalmic factors, such as pupil diameter and corneal multifocality.

Methods

Forty subjects (80 eyes) were included in this study, and the non-corrected distance and near visual acuity was measured and then converted to log MAR vision. The addition power for 33 cm near visual work was also measured and the accommodative power was measured by the push-up method. The HFC, accommodative lag and pupil size according to accommodative stimuli (−1.0 to −3.0 D) was measured by Speedy-i Autorefractor (Right Mfg Co., Tokyo). The corneal multifocality and corneal astigmatism was measured by corneal topography (TMS-4; Tomey, Erlangen, Germany).

Results

The mean age was 60.0 ± 4.66 years (51-68) and there were 23 male and 17 female subjects (1.35:1). The HFC and pupil size showed no significant change according to accommodation demand, however, the accommodative lag showed a statistically significant increase (p < 0.001 by one-way ANOVA). Accommodative lag (-2.0 D) showed a statistically significant negative correlation with the subjective accommodative power, and the pupil size (0 D) showed a positive correlation with the subjective accommodative power.

Conclusions

In presbyopia patients, the objective accommodative lag and initial pupil size showed a statistically significant relationship with subjective accommodative power. On the other hand, HFC, pupil size and corneal multifocality, alone may not be indicators to predict accommodative power, but these are important components to explain the dynamic aspect of accommodation.

Keywords: Accommodation, Accommodative lag, Accommodative microfluctuation, Corneal multifocality, Pupil size

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Figure 1.

The high-frequency component (HFC) of microfluctuation according to accommodative demand. There was no significant change in HFC according to stimulus (p = 0.379 by one-way ANOVA). Db = decibel.

Figure 2.

The accommodative lag according to accommodative demand. There was a significant increase in accommodative lag according to stimulus (p < 0.001 by one-way ANOVA). ^∗p < 0.001 by Scheffe & Bonferroni analysis.

Figure 3.

The pupil size according to accommodative demand. There was no significant change in pupil size according to stimulus, but the vertical axis showed more continuous constriction rather than horizontal as a result of near complex.

Table 1.

Baseline characteristics of eyes (n = 80)

	mean ± SD	Range
Age (years)	60.0 ± 4.67	51-68
Sex (M:F)	1.35:1
UCVA-far (log MAR)	0.27 ± 0.36	0.00-2.00
UCVA-near (log MAR)	0.75 ± 0.35	0.00-1.60
Sphere (diopter)	+0.67 ± 1.11	−2.00∼+3.00
Cylinder (diopter)	−0.67 ± 0.53	−1.75∼0.00
SE (diopter)	+0.32 ± 1.11	−2.63∼+2.50
Add power^∗ (diopter)	+2.15 ± 0.04	+ 1.50∼+3.00
Corneal multifocality (diopter)	1.52 ± 0.11	+0.23∼+3.23
Corneal astigmatism (sim K) (diopter)	−0.76 ± 0.74	−3.85-0.61
Accommodative power by push-up method (diopter)	4.50 ± 1.22	2.10-7.10

UCVA = uncorrected visual acuity; SE = spherical equivalent; SimK = simulated keratomerty.

^∗ Lens addition power for 33 cm near vision by progressive plus lens addition method.

Table 2.

High-frequency component (HFC) of accommodation and accommodation lag according to accommodation stimuli

Stimulus (diopter)	HFC (dB)	Accommodative lag (diopter)
-0.0	57.45 ± 5.31	0.15 ± 0.14
-1.0	58.16 ± 6.00	0.98 ± 0.28
-2.0	58.20 ± 5.61	2.00 ± 0.27
-3.0	59.07 ± 6.67	3.01 ± 0.33

Values are presented as mean ± SD; HFC: high-frequency component of accommodative microfluctuation; There was no significant change in HFC according to stimulus but, the accommodative lag showed a significant increase.

Table 3.

Pupil size according to accommodation stimuli

Stimulus (diopter)	Horizontal size (X) (mm)	Vertical size (Y) (mm)
-0.0	4.31 ± 0.89	4.27 ± 0.82
-1.0	4.26 ± 1.03	4.17 ± 0.93
-2.0	4.26 ± 1.10	4.09 ± 0.93
-3.0	4.30 ± 1.11	4.09 ± 0.94

Values are presented as mean ± SD; There was no significant change in pupil size according to stimulus, but the vertical axis showed more continuous constriction rather than horizontal as a result of near complex.

Table 4.

Pearson correlation analysis for accommodative power and other independent variables

	Correlation coefficients	p-value^∗(p < 0.05)
Age (years)	0.214	0.061
Sphere	−0.207	0.066
Cylinder	−0.032	0.776
SE	−0.208	0.064
-0.0 D HFC	−0.105	0.355
-1.0 D HFC	0.028	0.806
-2.0 D HFC	−0.047	0.678
-3.0 D HFC	−0.022	0.847
-0.0 D accommodative lag	−0.134	0.238
-1.0 D accommodative lag	0.011	0.925
-2.0 D accommodative lag	−0.406	<0.001^†
-3.0 D accommodative lag	0.065	0.565
UCVA (far)	0.202	0.073
UCVA (near)	−0.181	0.109
0 D pupil size x	0.365	0.001^†
0 D pupil size y	0.301	0.007^†
-1.0 D pupil size x	0.161	0.154
-1.0 D pupil size y	0.088	0.440
-2.0 D pupil size x	0.060	0.600
-2.0 D pupil size y	−0.050	0.658
-3.0 D pupil size x	0.109	0.336
-3.0 D pupil size y	0.068	0.552
Sim K	−0.206	0.100
Corneal multifocality	−0.175	0.223

SE = spherical equivalent; D = diopter; HFC = high-frequency component of accommodative microfluctuation; UCVA = uncorrected visual acuity; SimK = simulated keratomerty.

^∗ Pearson correlation analysis;

^† -2.0 D accommodative lag showed a statistically significant negative relationship between the accommodative power and pupil size (0 D) showed a positive relationship between the accommodative power.

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