Assessment of Accommodative Changes in Myopic Patients with Asthenopic Symptoms: A Prospective Observational Study

Abstract

Background: Myopia is a widespread refractive error characterized by an inability to clearly see distant objects due to the eye’s axial length being longer than normal or its refractive components being too strong. This condition can lead to asthenopia—symptoms such as eye strain, headache, and blurred vision—especially during prolonged near tasks. While refractive correction alleviates symptoms for many, some patients continue to experience discomfort due to undiagnosed accommodative anomalies. This study aims to evaluate accommodative dysfunctions in untreated myopic individuals presenting with asthenopic symptoms. Methods: A prospective observational study was conducted at an urban tertiary eye care center in North India. Ninety-eight subjects aged 18–39 years with untreated myopia and asthenopic symptoms were included. All underwent refraction and a full orthoptic workup including negative and positive relative accommodation (NRA, PRA), near point of accommodation (NPA), monocular estimated method (MEM), and other binocular function tests. Glasses were prescribed based on refraction results, and patients were reassessed after six weeks to evaluate symptom resolution. Persistent cases were investigated for accommodative insufficiency (AI) or accommodative excess (AE). Results: Among the 98 participants, 56 were female and 42 were male, with a mean age of 24.13 ± 6.22 years. Distribution of refractive errors showed that 23% had simple myopia (SM), 5% moderate myopia (MM), 43% simple myopic astigmatism (SMA), and 29% compound myopic astigmatism (CMA). After spectacle correction, 26.53% of participants reported symptom relief. However, 73.47% continued to have symptoms and were found to have accommodative dysfunction—43.88% had AI and 29.59% had AE. SMA patients had the highest AI prevalence. Conclusion: Accommodative dysfunctions are significantly prevalent in untreated myopic individuals with asthenopic symptoms, particularly in those with astigmatic components. Comprehensive accommodative evaluation should be a routine component of optometric examination in symptomatic myopic patients, even after refractive correction.