Spasm of Near Reflex: Objective Assessment of the Near-Triad.

Purpose To characterize binocular steady-state accommodation, pupil and convergence responses (near triad) in spasm of near reflex (SNR) before and after optical and pharmacological intervention. To identify the putative source of SNR in the neural control schema of accommodation-vergence interaction using controls-engineering modeling. Methods Near-triad of 15 patients with SNR (9 to 23 years) was recorded using an infrared photorefractor at 2m viewing distance for 120s during clinical presentation, after optical fogging intended to relieve spasm, with cycloplegia, post-cycloplegia and long-term follow-up visits. Data were also collected without cycloplegia in 15 age-matched controls. Schor (1999) model was used to computationally simulate accommodation and vergence responses of controls and SNR. Results Both eyes of SNR exhibited significant myopia and refraction fluctuations ( 0.1). Conclusions Exaggerated fluctuations of steady-state accommodation may be a signature feature of SNR, even while their pupil and convergence responses may remain unaffected. These fluctuations may arise from the tonic accommodation controller, the properties of which could be potentially altered after optical fogging to relieve the disorder.