Wavefront sensing: A breakthrough for objective evaluation of dynamic accommodation in accommodative dysfunctions

The purpose of this study was to use wavefront sensing as an objective method to detect and assess dynamic accommodation in subjects with accommodative dysfunctions and symptoms related to near-vision tasks. Sixty-three subjects were divided into control (N = 18), symptomatic without any accommodative dysfunction (SWD) (N = 18), infacility of accommodation (INFA) (N = 6), excess of accommodation (EA) (N = 9), and insufficiency of accommodation (INSA) (N = 12) groups. Accommodation was stimulated in different cycles of accommodation and disaccommodation while ocular aberrations were measured. Dynamic accommodation was computed from ocular wavefront aberrations and then analysed, including response time, peak velocity, and microfluctuations. Subjects with accommodative dysfunctions showed alterations in accommodative responses compared to the control group, characterized by slower and excessive/reduced responses, as well as an increase in accommodative microfluctuations and difficulty in relaxing accommodation to different accommodative demands. The SWD group showed significant changes compared to the control group, suggesting accommodative problems not previously detected in clinical examinations and explaining the symptoms reported by these subjects. The specific patterns of the characteristics of dynamic accommodation are presented for the different accommodative dysfunctions. The objective assessment of dynamic accommodation using wavefront sensing, analysed for different accommodative demands, provides a comprehensive approach to the detection and characterisation of accommodative dysfunctions. This method enables the improvement of the precision of the diagnosis of accommodative dysfunctions and allows its detection in cases that may not be detected by current clinical examinations. In addition, this method may contribute to personalized treatment planning, potentially improving patient outcomes in clinical practice.