Oculomotor function in incipient presbyopia

The incipient phase of presbyopia represents a loss in accommodative amplitude of approximately 3 dioptres between the ages of 35 and 45 and is the prelude to the need for a reading addition. The need to maintain single binocular vision during this period requires re-calibration of the correspondence between accommodation and vergence response. No previous study has specifically attempted to correlate change in accommodative status with the profile of oculomotor responses occurring within the incipient phase of presbyopia. Measurements were made of the amplitude of accommodation, stimulus and response AC/A ratios, CA/C ratio, tonic accommodation, tonic vergence, proximal vergence, vergence adaptation and accommodative adaptation of 38 subjects. Twenty subjects were aged 35 to 45 years of age and 10 subjects were aged 20 to 30 years of age at the commencement of the study. The measurements were repeated at four-monthly intervals for a total of two years. The results of this study fail to support the Hess-Gullstrand theory of presbyopia with evidence that the effort to produce a unit change in accommodation increases with age. The data obtained has enabled the analysis of how each individual oculomotor function varies with the decline in amplitude of accommodation. MATLAB/SIMULINK software has been used to assist in the analysis and to allow the amendment of existing models to represent accurately the ageing oculomotor system. This study has proposed that with the decline in the amplitude of accommodation there is an increase in the accommodative convergence response per unit of accommodative response. To compensate for this increase, evidence has been found of a decrease in tonic vergence with age. If this decline in tonic vergence is not sufficient to counteract the increase in accommodative convergence, it is proposed that the near vision response is limited to the maximum vergence response that can be tolerated, with the resulting lower accommodative response being compensated for by an increase in the subjective depth-of-focus. When the blur due to the decrease in accommodative response can no longer be tolerated, the first reading addition will be required.