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by Dr. Alexandria Wiss

The authors of Static Accommodation in Congenital Nystagmus are among those in optometry that are well-respected, distinguished, published authors and practitioners advancing the optometric field to new heights.

As a well-renowned author, Dr. Editha Ong has published a diverse array of articles often surrounding topics of normal and abnormal binocular vision. Such articles have led to more research, investigation, and support into these topics, allowing the advancement of optometric diagnoses and treatments.

As a Teaching Professor in the Department of Biological and Vision Sciences at the SUNY/State University of New York College of Optometry, Dr. Kenneth J. Ciuffreda is able to inspire new generations of optometrists while contributing to the research and documentation of optometry. Dr. Ciuffreda has written countless journal articles and chapters of many textbooks. His most current research studies the normal and abnormal oculomotor systems. Though this specific article was published in 1993, Dr. Ciuffreda is still eagerly researching effects of accommodation.

In addition to publishing numerous journal articles such as this one, Dr. Barry Tannen is also a co-author of a clinical textbook and lecturer. Dr. Tannen’s publications and lectures are often on topics associated with binocular vision, learning-related vision disorders, strabismus, amblyopia, and vision therapy. Through lecturing nationally and internationally, as well as through teaching vision therapy at SUNY/State University of New York College of Optometry, Dr. Tannen is dedicated to continuously advancing of the field of optometry.

This journal articles discusses the comparative study data of accommodative function between patients with normal vision and patients with congenital nystagmus. To maximize retinal-image quality, one must have the ability to alter the power of their lens, otherwise known as the ability to accommodate. By comparing the results of accommodative function between these patients, the study was able to determine a portion of the effects nystagmus has on overall visual function. Though only a small portion, approximately 0.025%, of the general population is predicted to have nystagmus, those who are effected often seek treatment options from optometrist that specialize in areas of binocular vision, frequently including specialist associated with COVD.

Though this study was limited by the number of participants, some general conclusions can be drawn. As many would predict, abnormal accommodative behavior was present in most participants with nystagmus, likely as a result of poor retinal-image quality from the motion of nystagmus. Study results correlated that under-accommodation compared to the normal is consistent with patients with varying ocular abnormalities, while over-accommodation is consistent with nystagmus. It is suggested that patients with nystagmus may over-accommodate unconsciously as an attempt to improve vision. Nystagmus may dampen in connection with the increased convergence from accommodation.

For patients with nystagmus, that had also undergone eye movement auditory biofeedback training, they were tested two ways. First without initiating any strategies learned during training and then a second test series with utilizing such strategies. Perhaps these results are the most interesting of the study. For those able to reduce their nystagmus with biofeedback techniques, accommodative accuracy improvement was statistically insignificant. The mean accommodative error at near did decrease however, but again the decrease was insignificant. Biofeedback training demonstrated that patients can develop an enhanced ability to dampen the nystagmus and re-establish foveation. It is encouraging that fixational ability can be improved, but it is important to note and educate patients it’s only a relatively small positive impact on accommodation.
The increased retinal-image motion in congenital nystagmus during significant developmental periods is most likely the cause of the degraded visual neurologic system. This degradation inhibits patients’ abilities to fine tune their vision, specifically their accommodation.

Our role as practitioners goes beyond simply solving the patient’s concerns, we must be able to address and educate patients on those specific concerns. Though this journal article did not present a solution to nystagmus or how to control accommodative dysfunction in nystagmus, it presents a foundation and gives practitioners data in which we can address nystagmus concerns for patients.

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