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    Amplitude of Accommodation

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    Amplitude of Accommodation

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    alwiugc.02
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    AMPLITUDE OF ACCOMMODATION

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    Amplitude of Accommodation

    Uploaded by

    alwiugc.02

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    © All Rights Reserved
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    of 5

    AMPLITUDE OF ACCOMMODATION

    DEFINITION:

    ⮚ Measures in diopters the patient's ability to change the focus of the crystalline lens in
    response to a near stimulus

    ⮚ Can be done using the push-up method

    D= 1/f (meters)

    D= 100/f (cm)

    D= 1000/f (mm)
    ACCOMMODATION D= 40/f (Inches)

    ⮚ Dioptric adjustment of the crystalline lens of the eyes to


    obtain clear vision for a given target of regard.

    AMPLITUDE OF ACCOMMODATION

    ⮚ Maximum amount of accommodation that the visual and ocular system can produce.

    ⮚ Expressed in diopters.

    HOFSTETTER FORMULAS:

    MINIMUM EXPECTED AMPLITUDE

    MIN= 15-0.25 (AGE)

    AVERAGE EXPECTED AMPLITUDE

    AVE= 18.5-0.30 (AGE)

    MAXIMUM EXPECTED AMPLITUDE

    MAX= 25- 0.40 (AGE)

    What will be the minimum, average, and expected amplitude of accommodation for a 28 year old
    patient?

    DONDER'S TABLE:

    DONDERS TABLE FOR AGE REFERENCED AMPLITUDE OF ACCOMMODATION


    AGE AMPLITUDE AGE AMPLITUDE

    10 14.00 45 3.50

    15 12.00 50 2.50

    20 10.00 55 1.75

    25 8.50 60 1.00

    30 7.00 65 0.50

    35 5.50 70 0.25

    40 4.50 75 0.00

    VT #19: AMPLITUDE ACCOMMODATION


    PURPOSE:
    • To measure the protection of accommodation pattern brought about by senility or advancing
    age
    • To determine the ADD or near correction

    Test Distance: 13 inches

    Test Target: J3 or .62 of Jaeger’s Card

    Lenses in Place: NON-PRESBYOPE – VT #7 (subjective finding)

    : PRESBYOPE – NET OF VT #14B/TNC

    P.D Adjustment: P.D at near

    Illumination: Normal

    Endpoint: Total Blur (Unable to recognize any letter)

    : NON-PRESBYOPE – increase (-) lens until total blur

    : PRESBYOPE – increase (+) lens until total blur

    COMPUTATION:

    TOTAL BLUR (VT #19)


    - LIP (VT #7)
    ANSWER
    - +2.50 (WORKING DISTANCE)
    FINAL ANSWER (NO SIGN)
    MAXIMUM ADA = 25 – 0.4 (AGE)
    AVERAGE ADA = 18 – 0.3 (AGE)
    MINIMUM ADA = 15- 0.25 (AGE)
    PROCEDURE:

    ● Instruct the patient to read near target. If the patient is non-presbyope decrease minus (-)
    sphere until total blur. If patient is presbyope, increase (+) sphere until total blur.
    ● Record this by subtracting gross of VT #19 from VT #7 and dioptric working distance of 2.50

    MEASUREMENT AND COMPUTATION OF AMPLITUDE

    Accommodation – It is the unique ability of eye to focus the diverging rays coming from a near
    object to see it clearly by changing the power of the crystalline lens which is the result of
    contraction of ciliary muscle.

    - There are three components of accommodation:


    o Near point of accommodation: It is the nearest point at which small objects
    can be seen clearly. That is why it is called Near point of accommodation or
    Punctum proximum.
    o Far point of accommodation: It is the distant or the farthest point where
    small objects can be seen clearly. That is why it is called Far point of
    accommodation or Punctum remotum.
    o Range of accommodation: The distance between the near point of
    accommodation or punctum proximum remotum is called range of
    accommodation.
    Amplitude of accommodation - is a measure of the closest point at which the eyes can focus: it
    is the range from the far point to the near point in diopters.

    - The difference between the dioptric power needed to focus at near point and far point.
    Amplitude of Accommodation (A) = P (near point) - R (far point).
    - Hofstetter formula:
    ● Maximum expected amplitude = 25 – 0.4 x Age
    ● Average expected amplitude = 18.5 – 0.3 x Age
    ● Minimum expected amplitude = 15 – 0.25 x Age
    Assessment of Amplitude of Accommodation - amplitude of accommodation can be
    assessed by five methods. Which are – push – up, push-down, push down to recognition, minus
    lens & dynamic retinoscopy. Four of the methods are completely subjective. Only the dynamic
    retinoscopy relies on the clinical interpretation that is why the method of dynamic retinoscopy is
    partly objective.

    1. Push-up: This method is omnipresent the ‘commonestand simplest’ clinical technique to


    asses amplitude of accommodation. In this procedure full refractive correction far
    distance is given to the patient. Then the patient is asked fix to the corrected near vision
    target at a distance where the target can be seen clearly. This is the usual method used.
    2. Push down: The push down method considered as a variation of push-up method. In this
    procedure the test target is moved away until the patient reports when it first becomes
    clear. Then the distance is measured and converted into dioptric value.
    3. Push down to recognition: This procedure is very similar to the push down method
    except the end-point is when the patient first recognizes the target object as it is moved
    away from the eye.
    4. Minus Lens: Far this process the patient is given his/her full refractive correction and
    each eye is tested separately.
    5. Dynamic Retinoscopy: In this procedure is determined by the practitioner with the
    observation of retinoscopic reflex. This procedure is performed in those patients who are
    having difficulties in communication.
    Example: 30 years old patient. You perform push-up amplitudes and the patient reports the target
    is blurry at 9 centimeters in the right eye, 10 centimeters in the left eye, and 8 centimeters in both
    eyes.

    ● OD NPA = 9 cm
    ● OS NPA = 10cm
    ● OU NPA = 8 cm
    Change centimeter to meter: 1cm = 0.01 m

    ● OD AA: 1/ .09 = 11.1 D


    ● OS AA: 1/ 0.10 = 10D
    ● OU AA: 1/ 0.08 = 12.5 D
    Hofstetter average expected amplitude:
    ● Average expected amplitude: 18.5 – 0.3 (30) = 9.5D
    Donder’s table:

    30 year old = 7.00 D

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