Wow Vision Therapy Blog

Accommodative Dysfunction – The 3 A’s of Eye Focusing that impact reading

Child with headache2 The following is an abridged articleåÊwritten by Dr. FortenbacheråÊand recently published onåÊThe VisionHelp Blog. In the original post Dr. Fortenbacher describes a true story of one of his patients åÊ”Jenny”åÊwhoåÊwas referred for treatmentåÊfor an Accommodative DysfunctionåÊby her primary care optometrist.

Accommodation, otherwise known as “eye focusing”, åÊis a vital visual function that provides the ability to adjust the lens system of the eye toåÊsee detail as an object is brought closer to the eyes.åÊ To read this article requires your eyes to accommodate (focus) on the print.åÊIn addition,åÊto read your eyesåÊmust stay “in focus” on the printed material for an extended period of time. What’s more you must do this with a high degree of precision in order to see the print clearly. And let’s not forget thatåÊwe must periodically look away and then back to the printed material. Therefore,åÊ for efficient reading and learning, a child’s eyesåÊmust engage in the “triple play” of eye focusing or what can be called the 3 “A’s” of Accommodation:

A # 1. Amplitude of Accommodation.This refers to the strength ability of focus.åÊThe greater the amplitude of accommodation means an object can beåÊheld closer to the eyes and sustained in focus for a longer periodåÊ of time.

A # 2. Accuracy of Accommodation: This refers to the ability to adjust the lens system of the eyes with precision to maintain optimal clarity of the viewed object.

A #3. Agility of Accommodation: This refers to the ability to adjust and change focus from near to far rapidly and without effort.

Symptoms ofåÊ Accommodative Dysfunction usually involvesåÊsome of the following:

  • Eye discomfort and/or headaches (often frontal headaches)åÊwith sustainedåÊclose work like reading
  • Squinting, blinking and rubbing eyes
  • Trouble copying from the chalkboard
  • Blurred vision when reading small print
  • Vision becomes worse by the end of the day
  • Reduced attention for reading
  • Poor reading comprehension

Accommodative Dysfunction has been studied and linked to an array of symptomsåÊ associated with near visual work such as reading or computer based tasks.åÊ It has also been linked to reading problems in children. Below are two interesting studies done within the last 5 years that shows there is scientific evidence to link Accommodative Dysfunction withåÊserious negative consequencesåÊon the lives of children:


Accommodative Function in School Children with Reading Difficulties. GraefesåÊArch ClinåÊExpåÊOphthalmol (2008), 1769-1774

Therefore research shows that good eye focusing (accommodation function)åÊisåÊessential toåÊreading, yet too oftenåÊthis area of visual dysfunction gains very littleåÊnotoriety. åÊ Currently theåÊrave is all about 3-D vision, 3-D movies, 3-DåÊ TV and 3-D games, butåÊåÊthere are no cool digital media devices like 3-D video games and movies that shed light on public awareness on Accommodation Dysfunction.åÊWhat’s more, school vision screenings will typically exclude testing of thisåÊvital visual function, even though it isåÊone of the most important “players” in your child’s “vision abilities team” for reading and learning.

What can be done to help children with Accommodative Dysfunction?The best approachåÊis usuallyåÊa combination approach of vision therapy to develop the visual brain learn which means the development ofåÊthe essential “neural-software” for effective and effortless coordination of the accommodative system andproperly prescribed readingåÊglasses.åÊ The best practices in åÊvision therapy approach isåÊoffice-based, doctor supervised optometric vision therapy. The best prescription for reading glasses are lenses with high-definitionåÊoptics to maximize the patients ability to not only focus but also to expand peripheral visual awareness. The importance ofåÊåÊprescription lensesåÊplus office-based vision therapy is toåÊdevelop a patient’s 3-As of accommodation so thatåÊvisual-stress related side effects involving frontal headaches go away andåÊthe act of reading and doing classroom learning becomes a visually effortless process.

And yesåÊwith this approach, the patient will have a happy ending; but only when a child isåÊfirst identified, usually by the primary care optometrist, åÊwho then makes the initial determination that a referral for treatment is required. If left to the public provided visual screenings children all around the country willåÊstill have to endure theåÊheadaches and eye discomfort because an unidentified accommodative dysfunction.

What if these kids didn’t have to struggle with an unaddressed visual deficiency of Accommodative Dysfunction? There is help available from doctors around the US and internationally, in private practice and University Clinics where optometric developmental vision and therapy services are provided.åÊ But first,åÊ the primary care eye doctor is usually where the patient with Accommodative Dysfunction is diagnosed and then referred for proper vision therapy care.

Will you help? If you are a doctor, occupational therapist or other professionalåÊwho works with children andåÊhaveåÊideas or suggestions toåÊ increase publicåÊawareness I welcome youråÊthoughts and comments on my post.åÊIf you are a patient, concerned family member, or public advocateåÊwho is åÊinterested in getting involved with others on this cause of vision advocacy, I encourage you to join Sovoto- The Vision Advocacy Network, take a look and contribute your thoughts to the discussion groups. Your involvement could make the difference in a child’s life!

Dan L. Fortenbacher, O.D., FCOVD