Measuring Accommodative Lag

Importance in Myopia Management

• Accommodative lag is crucial for understanding myopia progression risk in children.
• Helps determine appropriate prescription tools (contact lenses vs. spectacles).
• Linked to binocular vision considerations.

Tools Required

1. Flippers
   • Plus/minus range: 0.50 to 2.00
   • Markings: Circles for plus, minuses for minus.
2. RET (Retinoscope)
   • Used to obtain lag measurements.

Measurement Procedure

• Distance: Perform at a distance of 33-40 cm (reading distance, not normal distance).
• Flipper Technique:
  • Use flippers to overlay on the patient's eyes.
  • Hold multiple flippers for ease (up to three).
  • Quick measurement by flipping between different strengths (e.g., +0.50 to +1.00).
• Method:
  • Perform retinoscopy: observe reflex changes.
  • Aim for simultaneous coverage of both eyes.
  • Identify results by noticing reflex change (e.g., with +0.50 and against +1.00, result is +0.75).

Considerations

• Distance Vision Correction: Ensure distance vision is corrected before near retinoscopy.
• Targeting:
  • Use near cards or images for accommodative lock.
  • Ensures accurate simulation of real-life reading conditions.
• Additional Tips:
  • Use stronger flippers for greater lag.
  • Flippers useful for both distance and near retinoscopy.

Practical Demonstration

• Involve subjects for practice.
• Adopt different targets for children and adults.

Conclusion

• Accommodative lag measurement is straightforward with proper tools and technique.
• Practice using flippers and ret for quick, accurate assessments.