The effect of refractive error on the accommodative response gradient: a summary and update.

Purpose To give a summary of the original paper ‘The effect of refractive error on the accommodative response gradient’ published in 1986 and to present a brief overview of the most salient, subsequent findings which have appeared since then. Recent findings Intensive and prolonged near work as a precursor to myopia has been substantiated since the original paper and is thought to contribute to the remarkable increase in the prevalence of myopia in the world which has occurred in the last 30 years, consistent with the emergence of compulsory education, computers and urbanisation. Increased accommodation has not been found to be essential in the development of myopia, but inaccurate accommodation during near work in the form of accommodative lag with its consequent hyperopic defocus has been confirmed as an association with myopia, although it is not clear whether that association is causal or merely a consequence of myopia. Summary The premise of the original paper that near work engenders lower accommodation in myopes compared to emmetropes and hyperopes has been corroborated over the years, particularly in progressing myopes as distinct from stable adult myopes. Inaccurate accommodation resulting in accommodative lag has been amply confirmed in subsequent studies.