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Hypo-accommodation responses in hypermetropic infants and children
  1. Anna M Horwood1,
  2. Patricia M Riddell2
  1. 1University of Reading, Reading UK and Royal Berkshire Hospital, Reading, UK
  2. 2University of Reading, Reading, UK
  1. Correspondence to Dr Anna Horwood, School of Psychology and Clinical Language Sciences, University of Reading, Earley Gate, Reading RG6 6AL, UK; a.m.horwood{at}


Aims Accommodation to overcome hypermetropia is implicated in emmetropisation. This study recorded accommodation responses in a wide range of emmetropising infants and older children with clinically significant hypermetropia to assess common characteristics and differences.

Methods A PlusoptiXSO4 photorefractor in a laboratory setting was used to collect binocular accommodation data from participants viewing a detailed picture target moving between 33 cm and 2 m. 38 typically developing infants were studied between 6 and 26 weeks of age and were compared with cross-sectional data from children 5–9 y of age with clinically significant hypermetropia (n=15), corrected fully accommodative strabismus (n=14) and 27 age-matched controls.

Results Hypermetropes of all ages under-accommodated compared to controls at all distances, whether corrected or not (p<0.00001) and lag related to manifest refraction. Emmetropising infants under-accommodated most in the distance, while the hypermetropic patient groups under-accommodated most for near.

Conclusions Better accommodation for near than distance is demonstrated in those hypermetropic children who go on to emmetropise. This supports the approach of avoiding refractive correction in such children. In contrast, hypermetropic children referred for treatment for reduced distance visual acuity are not likely to habitually accommodate to overcome residual hypermetropia left by an under-correction.

  • Hyperopia: accommodation
  • ocular: infant: child: emmetropisation
  • optics and refraction
  • child health (paediatrics)

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  • Funding UK NIHR.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University of Reading & Berkshire NHS Ethics Committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.