Accommodative insufficiency is a condition where people struggle to focus on nearby objects, causing eye strain and discomfort. It is different from presbyopia and can be caused by medications, diseases, or eye problems. Treatment includes managing underlying conditions and vision therapy.
Accommodative insufficiency (AI) is a condition in which people have difficulty focusing on nearby objects, to an unusually poor degree for their age group. The condition can occur in young people and children and is not caused by a problem with the lens of the eye. This means that accommodative insufficiency is different from the disorder known as presbyopia, commonly found in people over the age of 40. In presbyopia, the lens loses its elasticity and its ability to adjust to close focusing. People with accommodative impairment typically experience eye strain when they do close-up work for an extended period.
In adults, accommodative insufficiency is more common in women than men. Diagnosing the disorder includes ruling out other similar conditions such as farsightedness, in which light is focused in a point behind the retina. Often the cause is unknown, but known causes of accommodative insufficiency include certain medications such as antidepressants, systemic diseases such as diabetes, and sometimes eye disease.
The condition is sometimes associated with another disorder known as convergence insufficiency (CI). In convergence insufficiency, the eyes don’t move inward effectively to allow accurate focus on something nearby. This causes what is known as asthenopia, a situation in which people experience discomfort and difficulty performing the types of tasks where close focusing is needed.
Common symptoms of accommodative insufficiency include general tiredness when reading, headaches, blurred vision, and eye strain. Loss of concentration and even motion sickness can occur. Individuals who spend a lot of time using computers, reading, or doing detailed, close-up work are more prone to developing symptoms associated with AI. Children with accommodative impairment may struggle with school work and may try to avoid reading whenever possible due to the discomfort they feel. Sometimes, children will assume their experience is normal, resulting in their symptoms not coming to light until they reach adulthood.
Treatment of accommodative insufficiency may involve managing an underlying condition, which could then lead to resolution of the problem. A treatment known as vision therapy may benefit some patients. Vision therapy is suitable for both adults and children. Therapy involves a personalized program in which an optometrist uses eye exercises, lenses, patches, and other equipment, working with the patient over a number of months. Glasses or contact lenses may also be needed and these can be used without visual therapy for patients who are unable to commit to a program.
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