Comparison of proximal and minus lens autorefraction techniques to measure monocular accommodative amplitude

SIGNIFICANCE: This study provides a faster method for objectively measuring accommodative amplitude with an open-field autorefractor in a research setting. PURPOSE: Objective measures of accommodative amplitude with an autorefractor take time because of the numerous stimulus demands tested. This study compares protocols using different amounts and types of demands to shorten the process. METHODS: One hundred participants were recruited for four age bins (5 to 9, 10 to 14, 15 to 19, and 20 to 24 years) and monocular amplitude measured with an autorefractor using three protocols: proximal, proximal-lens (letter), and proximal-lens (picture). For proximal, measurements were taken as participants viewed a 0.9 mm "E" placed at 13 demands (40 to 3.3 cm = 2.5 to 30 D). The other protocols used a target (either the "E" or a detailed picture) placed at 33 and 12.5 cm followed by 12.5 cm with a series of lenses (-2, -4, and -5.5 D). Adjustments were made for lens effectivity for the three lens conditions, which were thus 9.6, 11.1, and 12.0 D for individuals without additional spectacle lenses. Accommodative amplitude was defined as the greatest response measured with each technique. One-way analysis of variance was used to compare group mean amplitudes across protocols and differences between letter protocols by age bin. RESULTS: Amplitudes were significantly different between protocols (p < 0.001), with proximal having higher amplitudes (mean +/- standard deviation, 8.04 +/- 1.70 D) compared with both proximal-lens protocols (letter, 7.48 +/- 1.42 D; picture, 7.43 +/- 1.42 D) by post hoc Tukey analysis. Differences in amplitude between the proximal and proximal-lens (letter) protocol were different by age group (p = 0 .003), with the youngest group having larger differences (1.14 +/- 1.58 D) than the oldest groups (0.17 +/- 0.58 and 0.29 +/- 0.48 D, respectively) by post hoc Tukey analysis. CONCLUSIONS: The proximal-lens protocols took less time and identified the maximum accommodative amplitude in participants aged 15 to 24 years; however, they may underestimate true amplitude in younger children.