Accommodative lag before and after the onset of myopia

Donald O. Mutti, G. Lynn Mitchell, John R. Hayes, Lisa A. Jones, Melvin L. Moeschberger, Susan A. Cotter, Robert N. Kleinstein, Ruth E. Manny, J. Daniel Twelker, Karla Zadnik, Sandral Hullett, Janene Sims, Raphael Weeks, Sandra Williams, Lee Andra Calvin, Melvin D. Shipp, Nina E. Friedman, Pamela Qualley, Suzanne M. Wickum, Ailene KimBronwen Mathis, Mamie Batres, Sally Henry, Janice M. Wensveen, Connie J. Crossnoe, Stephanie L. Tom, Jennifer A. McLeod, Julio C. Quiralte, Julie A. Yu, Raymond J. Chu, Carmen N. Barnhardt, Jessica Chang, Kristine Huang, Rebecca Bridgeford, Connie Chu, Soonsi Kwon, Gen Lee, John Lee, Robert Lee, Raymond Maeda, Rachael Emerson, Tracy Leonhardt, Dawn Messer, Denise Flores, Rita Bhakta, Jodi M. Malone, Huan Sheng, Holly Omlor, Meliha Rahmani, Jaclyn Brickman, Amy Wang, Philip Arner, Samuel Taylor, Myhanh T. Nguyen, Terry W. Walker, Linda Barrett, Loraine Sinnott, Pamela Wessel, Julie N. Swartzendruber, Donald F. Everett

Research output: Contribution to journalArticlepeer-review

190 Scopus citations


PURPOSE. To evaluate accommodative lag before, during the year of, and after the onset of myopia in children who became myopic, compared with emmetropes. METHODS. The subjects were 568 children who became myopic (at least -0.75 D in each meridian) and 539 children who were emmetropic (between -0.25 D and +1.00 D in each meridian at all visits) participating between 1995 and 2003 in the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study. Accommodative lag was measured annually with either a Canon R-1 (Canon USA., Lake Success, NY; no longer manufactured) or a Grand Seiko WR 5100-K (Grand Seiko Co., Hiroshima, Japan) autorefractor. Subjects wore their habitual refractive corrections while viewing a letter target accommodative stimulus of 4 D (either in a Badal system or at 25 cm from the subject, designated Badal and near, respectively) or of 2 D (Badal only). Refractive error was measured with the same autorefractor in subjects under cycloplegia. Accommodative lag in children who became myopic was compared to age-, gender-, and ethnicity-matched model estimates of emmetropic values for each annual visit from 5 years before, through 5 years after, the onset of myopia. RESULTS. In the sample as a whole, accommodative lag was not significantly different in children who became myopic compared with model estimates in emmetropes in any year before onset of myopia for either the 4-D or 2-D Badal stimulus. For the 4-D near target, there was only a greater amount of accommodative lag in children who became myopic compared with emmetropes 4 years before onset (difference, 0.22 D; P = 0.0002). Accommodative lag was not significantly elevated during the year of onset of myopia in any of the three measurement conditions (P < 0.82 for all three). A consistently higher lag was seen in children after the onset of their myopia (range, 0.13-0.56 D; P < 0.004 for all comparisons). These patterns were generally followed by each ethnic group, with Asian children typically showing the most, African-American and white children showing the least, and Hispanic children having intermediate accommodative lag. CONCLUSIONS. Substantive and consistent elevations in accommodative lag relative to model estimates of lag in emmetropes did not occur in children who became myopic before the onset of myopia or during the year of onset. Increased accommodative lag occurred in children after the onset of myopia. Elevated accommodative lag is unlikely to be a useful predictive factor for the onset of myopia. Increased hyperopic defocus from accommodative lag may be a consequence rather than a cause of myopia.

Original languageEnglish (US)
Pages (from-to)837-846
Number of pages10
JournalInvestigative Ophthalmology and Visual Science
Issue number3
StatePublished - Mar 2006

ASJC Scopus subject areas

  • Ophthalmology
  • Sensory Systems
  • Cellular and Molecular Neuroscience


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