Eye Strain, Presbyopia, and Pseudomyopia

Care Using an Accommodation Analyzer

[Visualizing and explaining the “cause” of eye strain, presbyopia, and pseudomyopia]

◯ We graph the function of the muscle that adjusts focus (the ciliary muscle)

◯ We assess the state of eye strain, presbyopia, and pseudomyopia

○ orthoptistsperform the eye tests: prescribing appropriate glasses and contact lenses

✔ We make “accommodation” visible and provide care tailored to each person’s eyes.

About “Accommodation”

◯ Around the lens inside the eye is a muscle (the ciliary muscle). When you look at something near, the ciliary muscle works to make the lens bulge and bring it into focus (accommodation).

◯ With aging the lens becomes stiffer and accommodation weakens (presbyopia).

◯ Straining to see things up close is one cause of eye strain.
[Eye pain, blurred vision, glare, redness, pain behind the eyes, stiff shoulders, headache, nausea, and so on]

Along with “VDT syndrome” from computer use, we also hear the term “smartphone presbyopia,” which applies at any age.

The condition of the eye surface and the effect of tearscan also play a part.

When looking at something near, the eyes turn in slightly (convergence).
Sometimes the eyes cannot return from this inward turn.

Eye strain (tired eyes) can cause eyelid twitching.

Accommodation analyzer (Accommoref®)

In about 2 minutes for both eyes, we assess the effect on the ciliary muscle during accommodation, graph it, and show it on the monitor in the exam room.

Based on the results, we prescribe eye drops.

We also talk about lifestyle changes:
Looking into the distance from time to time can improve eye strain.

Besides accommodation, other causes of eye strain include:

• Refractive error (adjusting glasses and contact lenses)
• Heterophoria (balance of the positions of the two eyes)
• Convergence / divergence (movement of both eyes when looking at near objects)
• Dry eye　and so on.

.
Prism glasses may also be considered.

Appropriate glasses, as well asmultifocal contact lenses/low-add contact lenses

(a lens that places a distance power and a near power within a single contact lens),

may also work well.

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Care for Accommodation

Eye strain / presbyopia / pseudomyopia

[Eye Tests and Examination]

○ Basic tests
・Visual acuity test
・Refractive error (adjusting glasses and contact lenses)
・Heterophoria (balance of the positions of the two eyes)
・Convergence / divergence (movement of both eyes when looking at near objects)

○ Accommoref® (accommodation function analyzer)
About 50 seconds per eye. We quantify and graph the tremor of the ciliary muscle (High frequency component, HFC) as you watch a fireworks target approaching from infinity to 1 m, 50 cm, and 33 cm.

○ Slit-lamp microscope examination and screening for other eye diseases
* In particular, we check for the presence ofglaucoma, retinal disease, and cataract.
* Fluorescein staining: we observe the state of dry eye (the three-layer structure of tears).

We explain the results on a vertical monitor placed in front of you, and mainly provide the following.

[Eye Drop Prescriptions]
○ Cycloplegic: Midrin®-M (tropicamide), one drop once a day at bedtime
Acts on the parasympathetic nervous system and relaxes the ciliary muscle.

○ Accommodation-improving drug: Miopin® (neostigmine methylsulfate), one drop three times a day
Acts on the parasympathetic nervous system and helps the contraction function of the ciliary muscle.

○ Cycloplegic: atropine (diluted), one drop once a day
Atropine completely paralyzes accommodation by blocking the parasympathetic nervous system.

It is usually used for detailed examination of strabismus (esotropia) and amblyopia, and in the acute phase of iridocyclitis and uveitis.
If used undiluted, the pupil stays dilated for 1 to 2 weeks, which is not suitable for daily life (that is, mydriasis).
Diluted 100-fold, it almost never dilates the pupil.
We expect a stronger effect than Midrin®-M.

○ Eye drops fordry eye
We emphasize treatment aimed at suppressing inflammation.
Others include artificial tears and eye drops that promote mucin / aqueous secretion.

[Glasses and Contact Lens Prescriptions]
○ Glasses and contact lenses made in the past may now overcorrect.
　Distance vision is clear, but the ciliary muscle becomes more tense when looking at near objects

○ “I have always had good eyesight”
　Often this means mild hyperopia, and the ciliary muscle becomes more tense when looking at near objects.

○ Even for near work, the distance at which people look seems to differ from person to person.
・Long hours on smartphones / social media
・Studying for entrance exams
・PC work (computer)
・Playing music while reading sheet music
・Drawing fine, detailed pictures　
・Taking photographs through a viewfinder, and so on

✔ A full-time“orthoptist”listens to you and carries out tests tailored to each person.