The accommodative element in accommodative XXXX .

@entity1 @entity3467 @entity5971 @entity2516
PURPOSE: To evaluate the effect of reducing the hyperopic correction on the state of binocular accommodative response in fully accommodative @entity5971 and to determine the "comfortable" amount of reduction in hyperopic correction. DESIGN: A cohort study. METHODS: Hyperopic corrections of @entity1 with a baseline @entity2516 of +1.50 to +5.0 diopters were gradually reduced in 0.50-diopter increments. Binocular accommodative ability was assessed by dynamic retinoscopy (monocular estimate method). Similar binocular accommodative responses were ascertained among @entity1 with a baseline hyperopic correction of < or =3.0 of @entity3467 and >3.0 of @entity3467 , and @entity1 were divided into two groups, group 1 (13 @entity1 ) and group 2 (18 @entity1 ), accordingly. RESULTS: After a reduction of 2.0 diopters in group 1 and 1.0 diopter in group 2, there was a decrease in accommodative response initially in the nondominant eye, accompanied by the dominant eye with a further reduction of 0.50 diopter. To overcome the bilateral accommodative lag, a reinstatement of a 0.50-diopter stronger hyperopic correction was required. @entity1 in group 1 tolerated a mean undercorrection of 2.37 diopters, and 77% were weaned from their spectacles. All of the @entity1 in group 2 were dependent upon spectacles at the completion of the study period. The final spectacle worn was a median of -1.67 diopters less than their full cycloplegic refraction. CONCLUSIONS: A complete binocular accommodative ability seems to be a prerequisite for the establishment of "comfortable" hyperopic undercorrections. It does not seem to be a reasonable approach to consider further reductions in hyperopic correction in the presence of a bilateral decreased accommodative performance.
