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What is accommodative dysfunction?

Accommodative dysfunction simply means a focusing problem, particularly at near. This is not so much an eyesight (or clarity) difficulty as a problem in maintaining accurate, comfortable focus particularly with near work.

Focusing problems generally are not muscle problems. Occasionally, a child can fail to establish adequate focusing stamina during their early years of development, but in the vast majority of cases focusing dysfunction problems arise from fatigue as a result of sustained near visual tasks such as reading, writing, computer, etc. So, in a sense, this problem is an acquired one rather than something being innately wrong with your child’s visual system. Prolonged near tasks can be fatiguing to certain individuals. The visual effort required to try to cope with this task can sometimes cause a breakdown in the visual system leading to focusing dysfunction. This can even happen in the adult eye, especially if we are tired, run down or ill, or have commenced a new task with a lot of near work.

The symptoms associated with focusing dysfunction usually occur during or soon after close work. The symptoms may include, but are not limited to the following:

  • Visual discomfort, such as red or sore eyes, transient distance and/or near blur and headaches (usually frontal or temporal).
  • Difficulty sustaining near visual attention. This may result in avoidance of the tasks that produce visual stress.
  • Glare sensitivity or dizziness.
  • Rapid fatigue, even with a small amount of close work.
  • Abnormal posture adaptations such as head tilt or pulling the work away (some will pull their work closer).

Part of the treatment requires the prescribing of spectacle lenses for close work. In many cases this is all that is required. However, for some focusing disorders, visual therapy is also required. Visual therapy on its own does not work well to alleviate these problems. Therapy teaches better control but does not relieve the fatigue component.
If vision therapy is required it usually consists of six in-office visits spaced one week apart, along with home based therapy between these visits. Treatment duration will depend on the particular patient’s condition.

Visual hygiene must also be considered. Regular breaks from near tasks as well as a good working distance (generally elbow-to-fist) from reading or writing material is important.

Generally your child will be required to wear glasses for at least 12 to 36 months. As this problem occurs due to the stresses placed on the visual system with prolonged near work, the support of glasses may still be required for exam times, prolonged reading times, reading when tired or ill etc, even beyond the 36 months. Children who have reading glasses do not become dependent on them and do not get worse through the use of glasses. Ultimately it is expected that most children are weaned out of their glasses. Some children with these problems never improve sufficiently to stop wearing their glasses for reading completely. Your child should have regular reviews throughout their schooling life as the demands of the classroom change throughout the school years.