Your child's eyeglasses prescription can fluctuate due to accommodative spasms. Near work, stress, and more may contribute.
Have you ever been puzzled as to why your child's eyeglass prescription can seemingly change from one day to the next? Or perhaps you've sought a second opinion for your child and received a slightly different prescription. Accommodative spasms, a condition we're going to delve into in this article, could be the underlying reason.
What is an accommodative spasm?
So, your child is engrossed in a book, a tablet, or a smartphone screen for an extended period. Their eyes are working hard to focus on these close-up objects. When they finally shift their gaze to something in the distance, it might appear blurry. This phenomenon occurs because their eyes are still in "near" mode due to what is called an accommodative spasm, also referred to as ciliary spasm or spasm of accommodation.1
This condition can have a range of contributing factors, including excessive near-work, stress or anxiety, strabismus, head injuries, or ocular traumas. The result is that the ciliary muscle of the eye remains in a constant state of contraction. Normally, this muscle helps with adjustments for near-vision. However, when it's stuck in a perpetual state of contraction, it can't relax when viewing distant objects, resulting in blurred vision.1
A study published in 2017 reported that the difference in refractive error magnitude due to accommodative spasm ranged from 0.28 to 0.77 diopters in 6,825 children aged 4-15.3 Nevertheless, there were also reported rare case studies where the difference exceeded 7 diopters.2
A condition closely related to accommodative spasm is pseudomyopia, frequently referred to as near-work-induced transient myopia. It's crucial to differentiate pseudomyopia from myopia. Pseudomyopia is a reversible, functional condition due to accommodative spasms and can temporarily elevate the eye's refractive error. In contrast, myopia primarily results from the elongation of the eyeball, which represents a permanent structural alteration of the eye.3
How to assess accommodative spasms?
To assess the extent of accommodative spasms or determine if your child has pseudomyopia, eye specialists often employ a method known as cycloplegic refraction. This procedure uses cycloplegic eye drops to relax the ciliary muscle. Pseudomyopia is defined as if your child exhibits myopia of at least -0.50 diopters before cycloplegia and less than -0.50 diopters after cycloplegia.3
Although cycloplegic refraction is regarded as the gold standard for a more accurate refractive error assessment or diagnosing pseudomyopia, it is not consistently administered by eye doctors due to the required time, cost, and potential discomfort to children, including sensations of stinging, difficulties to focus, and dilated pupils. The results of this may lead to an overestimation of the magnitude of the refractive error.
How to treat accommodative spasms?
The primary objectives in addressing accommodative spasms are to relax the ciliary muscle and reduce the temporary increase in the refractive error. Here are some strategies to assist in achieving this:1
- Plus Correction Glasses or Contact Lenses: These corrective glasses or contact lenses can help your child's eyes reduce the tendency to overfocus and relax the accommodative system when reading or using digital devices. (Myopia control glasses or contact lenses have plus correction designed in, which is often also referred to as add power.)
- Encourage Eye Breaks: While studying or using screens, make sure your child takes regular breaks to look into the distance. This can help their eyes readjust to far-off objects.
- Limit Screen Time: Make sure the appropriate amount of daily screen time for your child, especially when it comes to smartphones and tablets. Reducing their exposure to close-up screens can benefit their eye health and decrease the likelihood of accommodative spasms.
- Spend Time Outdoors: Outdoor activities offer opportunities for your child to look at distant objects, aiding in relaxing their eyes and counteracting the effects of prolonged near work.
In some cases, your doctor may recommend the following:1
- Vision Therapy: In some cases, vision therapy may be recommended. This type of therapy can help relax the eye's focusing system and can be effective in managing accommodative spasms or pseudomyopia – the functional component. However, it does not address the structural change in myopia.
- Cycloplegic Drops: In severe cases, such as those involving trauma or injury, your eye doctor may prescribe cycloplegic drops to relax the eye's focusing muscles.
Conclusion
In summary, accommodative spasms introduce a unique dynamic to myopia management and may lead to a temporary and reversible change in a child's refractive error. It's essential for parents to grasp the distinction between the reversible functional condition and the structural change of myopia.
Accommodative spasms could be managed by using plus correction glasses, enforcing regular eye breaks, moderating screen time, and fostering outdoor activities. In certain cases, vision therapy or the use of cycloplegic drops may be advised by eye specialists.
Regular eye exams are indispensable for tracking and addressing any changes in your child’s vision. When a cycloplegic refraction is recommended by your eye doctor, recognize it as a valuable tool in gaining insights into your child's eye health. Maybe your child might not necessarily require new glasses or treatment; they might just need to relax or have more eye breaks.
- Manna, Prithwis et al. “Accommodative spasm and its different treatment approaches: A systematic review.” European journal of ophthalmology vol. 33,3 (2023): 1273-1286. doi:10.1177/11206721221136438.
- García-Montero, María et al. “Pseudomyopia: A Review.” Vision (Basel, Switzerland) vol. 6,1 17. 4 Mar. 2022, doi:10.3390/vision6010017.
- Sankaridurg,P.; He, X.; Naduvilath, T.; Lv, M.; Ho, A.; Smith, E.; Erickson, P.; Zhu, J.; Zou, H.; Xu, X. Comparison of noncycloplegic and cycloplegic autorefraction in categorizing refractive error data in children. Acta Ophthalmol. 2017, 95, e633–e640.
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