Random Changes of Accommodation Stimuli: An Automated Extension of the Flippers Accommodative Facility Test

Otero, Carles; Aldaba, Mikel; López, Silvia González; Díaz-Doutón, Fernando; Vera-Díaz, Fuensanta A; Pujol, Jaume

doi:10.1080/02713683.2018.1444181

Cited by 6 publications

(7 citation statements)

References 25 publications

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“…Sample size calculations were performed for each accommodative parameter investigated in this study with power set to 90% and the level of significance set to 0.05: For the amplitude of accommodation, using a standard deviation of 2.79 D for paired measurements [21], a sample size of 39 eyes would be needed to find a difference of 1.5 D [22]; for the accommodative response, using a standard deviation of 0.40 D for paired measurements for a stimulus of 2.50 D [23], a sample size of 29 eyes would be needed to find a difference of 0.25 D; finally, for the accommodative facility, using a standard deviation of 1.0 cpm for paired measurements [24], a sample size of 13 eyes would be needed to find a difference of 1.0 cpm.…”

Section: Statisticsmentioning

confidence: 99%

Changes in accommodative function following small-incision lenticule extraction for high myopia

et al. 2020

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Purpose To examine whether the amplitude of accommodation, the accommodative response, and the accommodative facility is affected and correlated with changes in higher-order aberrations for patients with high myopia surgically treated with small-incision lenticule extraction (SMILE). Methods 35 highly myopic eyes (myopic spherical equivalent of at least 6 diopters) of 35 patients treated with SMILE were included. Assessments were made before and 3 months after surgery. Donders push-up-method was used to measure the amplitude of accommodation. The accommodative response was assessed using an open-field autorefractor”Grand Seiko WAM-5500” (Grand Seiko Co. Ltd., Hiroshima, Japan) in combination with a Badal optometer and stimuli of accommodation at 0.0, 0.5, 1.25, 2.0, 3.0, and 4.0 D, respectively. Accommodative facility was measured at 40 cm with ±2,00D flipper lenses. All measurements of accommodation were performed monocularly with the refractive error corrected with soft contact lenses. Results The amplitude of accommodation did not change statistically significantly (mean difference -0.24 D (SD 0.98), 95% CI of mean difference -0.58 D to 0.11 D, paired-sample t(34) = -1.39; P = 0.17). The accommodative responses at 0.0, 0.5, 1.25, 2.0, 3.0, and 4.0 D did not statistically significantly change either (F(6,29) = 1.15; P = .36). Finally, the accommodative facility was also unchanged with a mean difference of 1.11 cycles per minute (SD 5.11, 95% CI of mean difference -0.64 to 2.87, paired-sample t(34) = 1.29; P = 0.21). No clinically significant associations between changes in accommodation and higher-order aberrations were found. Conclusions SMILE does not alter the amplitude of accommodation, the accommodative response, nor the accommodative facility for highly myopic patients, and the surgically induced corneal higher-order aberrations do not affect the accommodative function.

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Section: Statisticsmentioning

confidence: 99%

Changes in accommodative function following small-incision lenticule extraction for high myopia

et al. 2020

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“…The implementation of qualitative measures may provide some advantages in clinical practice by the objective assessment of accommodative facility. Nevertheless, as specified by Otero and colleagues, 9 it is important that accommodative facility tests are conducted under predictable conditions (i.e., two fixed focal planes), which is not what usually occurs in real‐world contexts. Moreover, further research is required to develop accommodative facility tests that are similar to everyday circumstances.…”

Section: Discussionmentioning

confidence: 99%

Effect of manipulating the vergence/accommodation and image size mismatches of the ±2D flipper test on the frequency and precision of accommodative facility

Vera

Redondo

Martínez-Tovar

et al. 2023

Ophthalmic Physiologic Optic

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Purpose The ±2.00 D accommodative facility test presents several limitations, including the lack of objective information and inherent characteristics such as vergence/accommodative conflict, change in apparent size of the image, subjective criteria for judging blur and motor reaction time. By using free‐space viewing conditions and an open‐field autorefractor to monitor the refractive state, we examined the impact of manipulating these factors on the qualitative and quantitative assessment of accommodative facility. Methods Twenty‐five healthy young adults (24.5 ± 4.5 years) took part in this study. Participants performed three accommodative facility tests (adapted flipper, 4D free‐space viewing and 2.5D free‐space viewing) under both monocular and binocular conditions in random order. A binocular open‐field autorefractor was used to assess the accommodative response continuously, and these data were used to characterise accommodative facility quantitatively and qualitatively. Results There were statistically significant differences between the three testing methods both quantitatively (p < 0.001) and qualitatively (p = 0.02). For the same accommodative demand, a lower number of cycles was obtained for the adapted flipper condition in comparison with the 4D free‐space viewing test (corrected p‐value < 0.001, Cohen's d = 0.78). However, this comparison did not reach statistical significance for qualitative measures of accommodative facility (corrected p‐value = 0.82, Cohen's d 0.05). Conclusions These data provide evidence that the qualitative assessment of accommodative facility is not influenced by the inherent limitations of the ±2.00 D flipper test. The use of qualitative outcomes by incorporating an open‐field autorefractor allows examiners to increase the validity of the accommodative facility test in both clinical and research settings.

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“…Otero and colleagues proposed an automated extension of the flippers accommodative facility test in order to minimize the delays in flipping the lenses, 15 and other authors have incorporated recordings of dynamic accommodation during the flippers test in order to obtain qualitative data. 16,17 However, there still exist limitations associated with accommodation/vergence conflicts and retinal image size.…”

Section: Introductionmentioning

confidence: 99%

Examining the Validity of a New Method for the Objective Assessment of Binocular Accommodative Facility (2Q-AF Test): A Comparison with ± 2.00 DS Lens Flippers

Vera

Redondo

Koulieris

et al. 2021

Current Eye Research

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Purpose: Recent technological advances have permitted to objectively record the accommodative response while shifting between two different levels of accommodation. This study is aimed at examining the concurrent validity of a new objective method for the qualitative and quantitative assessment of binocular accommodative facility, which is named 2Q-AF test, in comparison to the ±2.00 DS lens flippers. Methods: 56 individuals took part in this study (36 healthy young adults [24.4±3.2 years] and 20 children [12.2±0.4 years]). Participants randomly performed the 2Q-AF and the ±2.00 DS lens flipper tests. For the 2Q-AF test, a binocular open-field autorefractor was used to record the magnitude of accommodative response during a 60-sec period, while participants repeatedly changed fixation from a 5m to a 40cm chart when clarity of vision was achieved at each level.Due to the advantages of the proposed method, we have determined the number of cycles and the 2Q-AF score, with the latter also considering the accuracy of changes in accommodation. A standard procedure was followed for the ±2.00 DS flipper test. Results:Our data exhibited a moderate association between the number of cycles with the ±2.00 DS lens flippers and the number of cycles in the 2Q-AF test in the group of young adults (p=0.005, r=0.

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Random Changes of Accommodation Stimuli: An Automated Extension of the Flippers Accommodative Facility Test

Cited by 6 publications

References 25 publications

Changes in accommodative function following small-incision lenticule extraction for high myopia

Changes in accommodative function following small-incision lenticule extraction for high myopia

Effect of manipulating the vergence/accommodation and image size mismatches of the ±2D flipper test on the frequency and precision of accommodative facility

Examining the Validity of a New Method for the Objective Assessment of Binocular Accommodative Facility (2Q-AF Test): A Comparison with ± 2.00 DS Lens Flippers

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