The Accommodative Effort-Tolerance Deficit Hypothesis in High Myopic Presbyopes: Does Lifetime Spectacle Removal Reduce Tolerance for Sustained Accommodative Effort?

This preprint presents the Accommodative Effort-Tolerance Deficit (AETD) hypothesis, proposing that decades of habitual spectacle removal for near work may reduce tolerance for sustained accommodative effort in high myopic presbyopes. The manuscript integrates optical principles, accommodative physiology, behavioural adaptation, and clinical observations into a coherent, testable framework explaining why some high myopic presbyopes experience disproportionate intermediate visual discomfort despite adequate optical correction. The hypothesis generates explicit, falsifiable predictions and is intended to stimulate future clinical and experimental investigation. This work is shared as a preprint to facilitate scientific discussion and feedback while the manuscript undergoes peer review.