The following is an abridged article written by Dr. Fortenbacher and recently published on The VisionHelp Blog. In the original post Dr. Fortenbacher describes a true story of one of his patients "Jenny" who was referred for treatment for an Accommodative Dysfunction by her primary care optometrist.
Accommodation, otherwise known as "eye focusing", is a vital visual function that provides the ability to adjust the lens system of the eye to see detail as an object is brought closer to the eyes. To read this article requires your eyes to accommodate (focus) on the print. In addition, to read your eyes must stay "in focus" on the printed material for an extended period of time. What's more you must do this with a high degree of precision in order to see the print clearly. And let's not forget that we must periodically look away and then back to the printed material. Therefore, for efficient reading and learning, a child's eyes must engage in the "triple play" of eye focusing or what can be called the 3 "A's" of Accommodation:
A # 1. Amplitude of Accommodation.This refers to the strength ability of focus. The greater the amplitude of accommodation means an object can be held closer to the eyes and sustained in focus for a longer period of time.
A # 2. Accuracy of Accommodation: This refers to the ability to adjust the lens system of the eyes with precision to maintain optimal clarity of the viewed object.
A #3. Agility of Accommodation: This refers to the ability to adjust and change focus from near to far rapidly and without effort.
Symptoms of Accommodative Dysfunction usually involves some of the following:
- Eye discomfort and/or headaches (often frontal headaches) with sustained close work like reading
- Squinting, blinking and rubbing eyes
- Trouble copying from the chalkboard
- Blurred vision when reading small print
- Vision becomes worse by the end of the day
- Reduced attention for reading
- Poor reading comprehension
Accommodative Dysfunction has been studied and linked to an array of symptoms associated with near visual work such as reading or computer based tasks. It has also been linked to reading problems in children. Below are two interesting studies done within the last 5 years that shows there is scientific evidence to link Accommodative Dysfunction with serious negative consequences on the lives of children:

Accommodative Function in School Children with Reading Difficulties. Graefes Arch Clin Exp Ophthalmol (2008), 1769-1774
Therefore research shows that good eye focusing (accommodation function) is essential to reading, yet too often this area of visual dysfunction gains very little notoriety. Currently the rave is all about 3-D vision, 3-D movies, 3-D TV and 3-D games, but there are no cool digital media devices like 3-D video games and movies that shed light on public awareness on Accommodation Dysfunction. What's more, school vision screenings will typically exclude testing of this vital visual function, even though it is one of the most important "players" in your child's "vision abilities team" for reading and learning.
What can be done to help children with Accommodative Dysfunction?The best approach is usually a combination approach of vision therapy to develop the visual brain learn which means the development of the essential "neural-software" for effective and effortless coordination of the accommodative system andproperly prescribed reading glasses. The best practices in vision therapy approach is office-based, doctor supervised optometric vision therapy. The best prescription for reading glasses are lenses with high-definition optics to maximize the patients ability to not only focus but also to expand peripheral visual awareness. The importance of prescription lenses plus office-based vision therapy is to develop a patient's 3-As of accommodation so that visual-stress related side effects involving frontal headaches go away and the act of reading and doing classroom learning becomes a visually effortless process.
And yes with this approach, the patient will have a happy ending; but only when a child is first identified, usually by the primary care optometrist, who then makes the initial determination that a referral for treatment is required. If left to the public provided visual screenings children all around the country will still have to endure the headaches and eye discomfort because an unidentified accommodative dysfunction.
What if these kids didn't have to struggle with an unaddressed visual deficiency of Accommodative Dysfunction? There is help available from doctors around the US and internationally, in private practice and University Clinics where optometric developmental vision and therapy services are provided. But first, the primary care eye doctor is usually where the patient with Accommodative Dysfunction is diagnosed and then referred for proper vision therapy care.
Will you help? If you are a doctor, occupational therapist or other professional who works with children and have ideas or suggestions to increase public awareness I welcome your thoughts and comments on my post. If you are a patient, concerned family member, or public advocate who is interested in getting involved with others on this cause of vision advocacy, I encourage you to join Sovoto- The Vision Advocacy Network, take a look and contribute your thoughts to the discussion groups. Your involvement could make the difference in a child's life!
Dan L. Fortenbacher, O.D., FCOVD
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