Spasm of near reflex: a comprehensive management protocol and treatment outcomes

Roy, Saujanwita; Patil-Chhablani, Preeti; Satgunam, PremNandhini

doi:10.1016/j.jaapos.2021.02.010

Cited by 17 publications

(15 citation statements)

References 17 publications

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“…As we have described earlier, excessive accommodation and convergence could potentially contribute to the SAACE onset. Cycloplegic eye drops, which include cyclopentolate and atropine, have been reported to be effective on releasing spasm of the near reflex, especially the accommodation component [27]. Moreover, the prescription of atropine has also been reported to resolve Bielschowsky esotropia [16].…”

Section: Discussionmentioning

confidence: 99%

The effects of topical cycloplegics in acute acquired comitant esotropia induced by excessive digital device usage

Hayashi

Machida

2022

BMC Ophthalmol

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Background Acute acquired comitant esotropia induced by excessive digital device usage, especially smartphones (SAACE), has been increasing over the past few years. One suggested mechanism is convergence spasm induced by excessive near work, with refraining from digital device use considered to be an effective method for decreasing the degree of esodeviation. However, if symptoms persist and are untreated over time, recovery becomes more difficult. The present study evaluated the effects of topical cycloplegics on persistent SAACE untreated for over 1 year. Methods Patients with sustained SAACE that was untreated for over 1 year were evaluated. Digital device usage was discouraged and a topical cycloplegic, 0.4% tropicamide, was prescribed at bedtime. After obtaining informed consent, the 14 out of 23 enrolled patients who agreed to eye drop administration were defined as the study group, with the others serving as the controls. After a 3-month follow-up, patients who elected to undergo surgery were analyzed as the surgery group. Changes in esotropia angles, stereoacuity and diplopia complaints were evaluated after a 3-month follow-up. Results Esotropia angles decreased and stereoacuity improved after a 3-month treatment in the study group (P < 0.01). Diplopia disappeared in 13 patients (92.9%, totally disappeared or disappeared when using glasses with built-in prisms). Among 11 patients with untreated esotropia ranging from 1–3 years, decreases in esotropia angles were correlated to untreated esotropia duration (near: R = -0.6; distance: R = 0.7; both P < 0.05). Esotropia angles in the control group exhibited a tendency to increase while stereoacuity tended to deteriorate after the 3-month follow-up. As diplopia did not disappear in any patients, 7 elected to undergo surgery and were enrolled as the surgery group. While esotropia angles decreased in the study group, they were lower than the surgery group (P < 0.01), but higher than the control group (P < 0.01). Stereoacuity was worse in the control versus the study and surgery groups (both P < 0.05). Conclusion Results suggest short-acting topical cycloplegics are effective in SAACE patients with long untreated periods. Decreases in esotropia angles were negatively correlated to untreated esotropia duration, which suggests the necessity of early treatment.

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Section: Discussionmentioning

confidence: 99%

The effects of topical cycloplegics in acute acquired comitant esotropia induced by excessive digital device usage

Hayashi

Machida

2022

BMC Ophthalmol

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“…They recommended treating severe forms of spasm of the near reflex with efficacious cycloplegic drops despite their adverse effects. 38…”

Section: Methodsmentioning

confidence: 99%

“…3,32 Three studies compared the modified optical fogging technique with cycloplegic refraction and applied it as a method to stop the accommodative spasm when it was noticed after post-cycloplegic refraction. 8,36,38 The method involves requiring the patient to perform a close task while stabilising the patient's visual acuity and retinoscopy reflex. Satgunam reports that the two patients diagnosed with accommodative spasm after cycloplegic refraction used the modified optical fogging method to immediately relieve the spasm.…”

Section: Assessment and Diagnosismentioning

confidence: 99%

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Accommodative spasm and its different treatment approaches: A systematic review

Manna

Karmakar

Bhardwaj

et al. 2022

European Journal of Ophthalmology

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This article is about the accommodation spasm. The primary rule for near vision is ciliary muscle constriction, synchronised convergence of both eyes, and pupil constriction. Any weaknesses in these components could result in an accommodative spasm. Variable retinoscopic reflex, unstable refractive error, and lead of accommodation in near retinoscopy are common causes of spasm. We conducted a thorough literature search in the PubMed and Google Scholar databases for published journals prior to June 2022, with no data limitations. This review contains twenty-eight case reports, six cohort studies, four book references, four review articles, and two comparative studies after applying the inclusion and exclusion criteria. The majority of studies looked at accommodative spasm, near reflex spasm, and pseudomyopia. The most common causes of accommodative spasm are excessive close work, emotional distress, head injury, and strabismus. Despite side effects or an insufficient regimen, cycloplegic drops are effective in diagnosing accommodation spasm. The modified optical fogging technique is also effective and may be an option for treating accommodative spasm symptoms. Bifocals for near work, manifest refraction, base-in prisms, and vision therapy are some of the other management options. As a result, it requires a comprehensive clinical treatment strategy. This review aims to investigate the various aetiology and treatments responsible for accommodative spasm and proposes widely implementing the modified optical fogging method and vision therapy in clinics as comprehensive management to reduce the future upward trend of accommodative spasm.

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“…Der Akkommodationsspasmus tritt häufig in Zusammenhang mit einem sog. Konvergenzspasmus und einer (diagnostisch verwertbaren) Pupillenverengung auf, sodass man von Naheinstellungsspasmus sprechen sollte[19]. Die Pupillenverengung ist ein wichtiges differenzialdiagnostisches Kriterium, wenn es darum geht, einen Naheinstellungsspasmus von einer beidseitigen Abduzensparese abzugrenzen.Die Diagnose eines Akkommodations-oder Naheinstellungsspasmus wird häufig erst nach längerer Zeit gestellt.…”

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Akkommodation

Steffen¹

2022

Augenheilkunde up2date

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ZusammenfassungAkkommodation ist die natürliche Zu- oder Abnahme der Refraktion des Auges bei Änderung des Beobachtungsabstands. Sie beruht auf der Verformbarkeit der natürlichen Augenlinse. Durch Untersuchung der Akkommodation und der an sie gekoppelten Konvergenz lassen sich definierte Krankheitsbilder diagnostizieren und von neuroophthalmologischen Erkrankungen abgrenzen. Überflüssige diagnostische Maßnahmen werden so vermieden, Patientenängste reduziert.

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Spasm of near reflex: a comprehensive management protocol and treatment outcomes

Cited by 17 publications

References 17 publications

The effects of topical cycloplegics in acute acquired comitant esotropia induced by excessive digital device usage

The effects of topical cycloplegics in acute acquired comitant esotropia induced by excessive digital device usage

Accommodative spasm and its different treatment approaches: A systematic review

Akkommodation

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