COMPARISON OF PLUS LENS ADDITION VERSUS VISION THERAPY FOR THE MANAGEMENT OF ACCOMODATION INFACILITY

Background: Accommodation is the process by which the eye adjusts its lens to maintain a clear focus on objects at varying distances, primarily controlled by the ciliary muscle. Accommodative dysfunction, particularly accommodative infacility, impairs this ability, leading to symptoms such as blurred vision, eye strain, headaches, and difficulty with reading and other near-vision tasks. Managing this condition is crucial for improving visual comfort and function. Plus lens addition and vision therapy are two widely used treatment approaches, yet their comparative effectiveness remains unclear. Objective: This study aimed to evaluate and compare the effectiveness of plus lens addition versus vision therapy in managing accommodative infacility. Methods: A randomized controlled trial was conducted at the Ophthalmology Eye Outpatient Department of Al Rehman Hospital and Dar ul Shifa Eye Hospital, Lahore, over six months following ethical approval. A total of 38 participants, aged 15 to 35 years, with newly diagnosed accommodative infacility, were randomly assigned into two equal groups: plus lens addition (n = 19) and vision therapy (n = 19). Comprehensive baseline assessments included visual acuity, near point of accommodation (NPA), near point of convergence (NPC), amplitude of accommodation (AA), negative relative accommodation (NRA), positive relative accommodation (PRA), monocular fixation (MF), and binocular fixation (BF). Each treatment was administered for six weeks, followed by post-treatment evaluations using the same standardized instruments. Data were analyzed using SPSS Version 27, employing descriptive statistics, the Wilcoxon signed-rank test, and ANOVA. Results: Post-treatment, the vision therapy group exhibited significantly greater improvement in NPA (7.8 ± X vs. 10.5 ± X, p < 0.001), AA (10.1 ± X vs. 8.9 ± X, p < 0.001), PRA (-3.0 ± X vs. -2.7 ± X, p = 0.002), and NPC (6.862 ± 0.70 vs. 14.09 ± 1.24, p < 0.05) compared to the plus lens group. Both groups showed statistically significant enhancements in all visual function parameters (p < 0.05). Conclusion: While both plus lens addition and vision therapy were effective in improving accommodative function, vision therapy demonstrated superior outcomes in enhancing accommodation flexibility, convergence, and binocular stability. These findings support the recommendation of vision therapy as a preferred intervention for long-term improvement in accommodative infacility.