Habitual Accommodative Excess: Current State of the Problem

Accommodation disorders play an important role in the formation and progression of refractive errors in the modern world. Habitual accommodative excess is observed in patients starting from childhood up to the age of presbyopia, and may have a different nature. This article summarizes prevailing ideas about etiology, classification, diagnosis and treatment of accommodation disorders. The authors of the article proposed their own etiopathogenetic classification of habitual accommodative excess, which includes following groups: habitual accommodative excess in progressive myopia; habitual accommodative excess in uncorrected hyperopia and/or astigmatism; habitual accommodative excess at pre-presbyopic age; habitual accommodative excess in patients taking psychotropic medications; habitual accommodative excess as a result of acute ciliary stress after refractive surgery; habitual accommodative excess due to anisometropia; habitual accommodative excess in patients with keratoconus. The concept of acute ciliary stress was introduced for the first time. Acute ciliary stress is characterized by acute dysfunction of the ciliary muscle in early postoperative period of refractive surgery due to exposure to a femtosecond laser vacuum ring and microvascular dysfunction. This classification includes not only the causes and mechanisms of development of accommodation disorders, but also includes a differentiated approach in treatment of habitual accommodative excess.