Accommodative Lag and Juvenile-onset Myopia

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April 1, 2025

By Samrat Sarkar, PhD Candidate at the University of New South Wales

Juvenile-onset myopia, also known as early-onset myopia or school myopia, commonly occurs between 8 and 13 years of age¹ and mainly progresses during the teenage years.² The prevalence of juvenile-onset myopia in school-going children is high in East Asia, ranging from 23.3% to 65.5%.³ Studies on animal models show exposure to myopic defocus induced by a positive lens and exposure to hyperopic defocus induced by a negative lens decreases and increases axial length elongation, respectively.⁴

Previously, a study reported that with optimum vision, children with myopia showed a greater accommodative lag than children with emmetropia during near work.⁵ The greater lag of accommodation results in blur cues due to hyperopic defocus. Myopic children likely use the blur cues to increase their accommodation during near work.⁶ This process accelerates axial elongation and results in juvenile-onset myopia.^6-9 However, inconsistent findings have been reported about this association between accommodative lag and juvenile-onset myopia.

Association Between Accommodative Lag and Juvenile-onset Myopia

In 2006, observation from the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) study between 1995 and 2003 reported no significant increase in accommodative lag during the onset of myopia in a large sample of American children. However, a consistent increase in accommodative lag was observed after the onset of myopia.¹⁰

On the other hand, in 2008, a one-year longitudinal study on Chinese children reported no association between accommodative lag and myopic progression.¹¹ In 2011, the CLEERE study of 592 children wearing single-vision spectacles investigated the relationship between accommodative lag and juvenile-onset myopia progression. The study reported no association between accommodative lag and myopia at the start or end of a yearly myopia progression.¹² Further, a follow-up study reported no association between accommodative lag and myopia progression in myopic children using randomly assigned single-vision or progressive addition lenses.¹³ 

Requirement of More Research on Accommodative Lag and Juvenile-onset Myopia 

Although studies have reported no association between accommodative lag and juvenile-onset myopia, a detailed binocular vision evaluation, including the assessment of accommodative lag or lead in children, including myopic, or pre-myopic population, is recommended. Also, it is important to consider that accommodative lag varies between the measurement method, targets and metrics.¹⁴

The other important factor to consider is the role of near work and childhood myopia development. Although some studies have reported an association between near work and myopia development, others have not.¹⁵ The real-time quantification of habitual near-viewing duration^16,17 and distance,¹⁸ along with the clinical assessment of accommodative behavior is recommended for pre-myopic, myopic and emmetropic children. Ideally, a longitudinal study on the association between real-time habitual near-viewing duration or distance and accommodative behavior is required to understand the role of accommodative lag in the development or progression of juvenile-onset myopia. 

 

Smrat Sarkar is a PhD Candidate at the School of Optometry and Vision Science at the University of New South Wales. He is undertaking a PhD research project on the role of near vision behavior in myopia progression among children. As a qualified optometrist, he has extensive clinical and research experience in the eye health sector.

 

References

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