Accommodation and near visual function in children with albinism

Purpose Albinism degrades visual function due to developmental disorders of the eye and visual pathways, larger refractive errors, absent binocularity and poor fixation control. Reading spectacles is commonly prescribed in our clinic and well tolerated. The purpose was to evaluate whether the accommodative response is typical or affected in comparison to a reference group. Methods Twenty-two children with albinism (median: 13.5 years) and 12 controls (median: 13 years) underwent a full optometric examination and an objective accommodation measurement (WAM-5500 @ 6 Hz; Grand Seiko) in response to minus-lens-blur (-1, -2 and -3 D) and to a prolonged near viewing task (20 cm) for 5 min. Results Children with albinism displayed less accommodation to minus lens-blur and during sustained near viewing (p < 0.001) compared to the reference group. Higher visual acuity correlates with a better accommodative response (r >= 0.5; p <= 0.04). The subjective and objective measures of accommodation did not correlate. The habitual reading distance was always closer than the point towards which the subjects with albinism seemed to accommodate according to the measurements at 20 cm. Conclusion Children with albinism benefits from reading spectacles due to a combination of close habitual reading distance and a poor accommodation. Objective recording of accommodation is not critical for a correct judgement of near visual function. Children already wearing reading spectacles were those with least accommodative response.