Assessment and Clinical Classification of Accommodative Dysfunctions in Non-presbyopic Patients: A Narrative Clinical Review

This review aims to provide a summary of the present knowledge in the assessment and classification of accommodative dysfunctions in non-presbyopic patients, with special emphasis placed on the impact of the assessment techniques and protocols employed in the measurement of the dysfunctions. The most commonly employed clinical and objective techniques in the assessment of accommodative dysfunctions are discussed, in addition to the major limitations and diagnostic biases associated with the techniques. The major accommodative dysfunctions include insufficiency, infacility, spasm, fatigue, and paresis, while the most striking limitations in the assessment of these dysfunctions include inconsistencies in the assessment techniques and protocols employed, as well as the diagnostic criteria and norms. A pragmatic approach for the diagnosis of the dysfunctions is proposed with the aim of enhancing the specificity of the diagnostic techniques employed in the assessment of the dysfunctions. Standardization of the techniques and protocols employed in the assessment of the dysfunctions, in addition to the integration of objective dynamic techniques in the assessment of the dysfunctions, may help in the elimination of the diagnostic biases associated with the assessment techniques employed. This narrative review was developed using recent peer-reviewed articles retrieved from major scientific databases, including PubMed, ScienceDirect, Wiley Online Library, and Scopus, with emphasis on clinically relevant and recent publications.