Newly published research shows that anisometropic amblyopes often exhibit asymmetric accommodative responses between eyes, which adversely affects visual acuity potential. “Amblyopic eyes with a lead of accommodation in the distance, and a lag at near, have a poorer prognosis following occlusion therapy,” explains Jasleen Jhajj, OD, an assistant professor at Nova Southeastern University who teaches on binocular vision and vision therapy.

The study looked at the accommodation responses of 26 children with anisometropic amblyopia. The final visual acuity in the amblyopic eye, after treatment, was compared between those with symmetrical, aniso-, and anti-accommodation. The UK-based research team found a significant difference in final visual acuity between the three accommodation groups, and those with anisometropic amblyopia with anti-accommodation had the poorest final acuity. The initial visual acuity in the amblyopic eye and the degree of anisometropia were also significantly positively correlated with final visual acuity.

Dr. Jhajj says optometrists should consider prescribing unequal adds for patients who continue to exhibit accommodative anomalies following initial cycloplegic correction. Patients who plateau with occlusion therapy should be checked for accommodative dysfunction and referred for vision therapy to achieve optimal acuity. 

Toor S, Horwood A, Roddell P. The effect of asymmetrical accommodation on anisometropic amblyopia treatment outcomes. J AAPOS. July 10, 2019. [Epub ahead of print].