Objective changes in astigmatism during accommodation

Abstract

Purpose: Previous studies have shown small but clinically significant changes in the power and axis of astigmatism when the eye accommodates. Monocular objective measurements of the eye during accommodation, when the object approaches the eye without convergence, also reveal small astigmatic changes. Moreover, it is known that the eye exhibits ocular cyclotorsion at different gaze angles. Since accommodation and convergence normally occur simultaneously, we studied the change in the magnitude and axis of astigmatism during accommodation for different convergence angles.

Methods: The left eye of 15 subjects between 20 and 49 years old (mean 28.5 ± 9.7 years) having ≤1.5 D astigmatism was evaluated. Measurements were made using a Shack-Hartmann aberrometer for an accommodation range of +0.50 D to -10 D in 0.50 D steps, and for four monocular convergence demands: 0°, 5°, 10° and 15°. Statistical analysis used power vectors to quantify the change in cylinder power and axis for each accommodation and convergence demand with age.

Results: Jackson cross-cylinder component J₄₅ did not change during accommodation for all vergences tested. However, J₀ changed by an average of -0.02 D per dioptre of accommodation (D/Dacc) for convergence demands of 0°, 5° and 10° and -0.03 D/Dacc for the 15° demand. This corresponds to an average cylinder power change of -0.05 D/Dacc for convergences of 0°, 5° and 10° and -0.08 D/Dacc for 15° of convergence. The cylinder axis always changed towards 90° (against-the-rule), and age did not play a significant role.

Conclusions: Except for accommodation demands >4 D, we did not find a clinically significant change in astigmatism for convergence angles up to 15º. The small changes in cylinder power and axis may be due to shifts in the position of the crystalline lens during accommodation.

Keywords: accommodation; accommodative astigmatism; astigmatism; monocular convergence.