{
    "abstract": "To determine the utility of root mean squared (RMS) deviations of steady-state accommodation as a noncycloplegic marker for spasm of near reflex (SNR) vis-\u00e0-vis regular refractive errors.\nBinocular steady-state responses of accommodation, pupil, and vergence of 20 patients with accommodative spasm subtype of SNR (SNR-A; 9-23 years) and 91 with regular refractive errors (29 emmetropes, 41 myopes, 21 hyperopes; 19-38 years) was recorded in the uncorrected refractive error state for 120 seconds using a dynamic (50 frames per second), infrared photorefractor. Mean and RMS deviation of raw data was calculated for three 20-second-long epochs and their diagnostic utility was determined using standard ROC curves.\nRMS deviations of accommodation increased with mean refractive error in SNR-A (y = -0.23x + 0.38; r2 = 0.69; P < 0.001) and regular refractive error (y = -0.02x + 0.10; r2 = 0.14; P = 0.002) cohorts, albeit with steeper slope and higher y-intercept in the former rather than the latter cohort. RMS deviation of 0.19D reliably distinguished SNR-A from regular refractive errors with a sensitivity and specificity of 95.2% and 92.2%, respectively [mean (\u00b11 SEM) area under ROC curve: 0.98 \u00b1 0.01]. The sensitivity, specificity, and area under ROC curve for RMS deviations of pupil (66.7%, 80%, and 0.70 \u00b1 0.09) and vergence (52.4%, 84.6%, and 0.68 \u00b1 0.08) were smaller than accommodation.\nRMS deviations of steady-state accommodation is a robust noncycloplegic marker for differentiating SNR-A from regular refractive errors. Pupil and vergence fluctuations have limited utility in this regard.\nRMS deviations of accommodation may be easily obtained using commercial photorefractors, and the cut-off values reported herein may be implemented to identify SNR-A during refractive error screening.",
    "authors": [
        {
            "affiliation": "Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India.\nProf Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India.",
            "firstname": "Shrikant R",
            "initials": "SR",
            "lastname": "Bharadwaj"
        },
        {
            "affiliation": "Prof Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India.",
            "firstname": "Chandrika",
            "initials": "C",
            "lastname": "Ravisankar"
        },
        {
            "affiliation": "Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India.",
            "firstname": "Saujanwita",
            "initials": "S",
            "lastname": "Roy"
        },
        {
            "affiliation": "Brien Holden Institute of Optometry and Vision Sciences, L V Prasad Eye Institute, Hyderabad, India.\nProf Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India.",
            "firstname": "PremNandhini",
            "initials": "P",
            "lastname": "Satgunam"
        }
    ],
    "conclusions": null,
    "copyrights": null,
    "doi": "10.1167/tvst.10.11.9",
    "journal": "Translational vision science & technology",
    "keywords": [],
    "methods": null,
    "publication_date": "2021-09-08",
    "pubmed_id": "34491286\n8658338\n30196785\n34102258\n24605432\n34905525\n6884172\n17659966\n25658329\n28503812\n26686513\n24641244\n29930099\n19874105\n28976783\n25271145\n27161520\n32663291\n17993577\n29877334\n21104269\n25613165\n19146280\n31318801\n21482712\n23252852\n21350700\n6747180\n16390487\n16545421\n18174839\n12601026\n29401180\n14641262\n11100892\n525283\n23695324\n16772892\n19390473\n8350267\n8446375\n8145991\n32859718",
    "results": "RMS deviations of accommodation increased with mean refractive error in SNR-A (y = -0.23x + 0.38; r2 = 0.69; P < 0.001) and regular refractive error (y = -0.02x + 0.10; r2 = 0.14; P = 0.002) cohorts, albeit with steeper slope and higher y-intercept in the former rather than the latter cohort. RMS deviation of 0.19D reliably distinguished SNR-A from regular refractive errors with a sensitivity and specificity of 95.2% and 92.2%, respectively [mean (\u00b11 SEM) area under ROC curve: 0.98 \u00b1 0.01]. The sensitivity, specificity, and area under ROC curve for RMS deviations of pupil (66.7%, 80%, and 0.70 \u00b1 0.09) and vergence (52.4%, 84.6%, and 0.68 \u00b1 0.08) were smaller than accommodation.",
    "title": "Fluctuations of Steady-State Accommodation Is a Marker for Screening Spasm of Near Reflex.",
    "xml": "<Element 'PubmedArticle' at 0x7885031efa60>"
}