Diagnostics and restorative treatment of accommodation astenopia from the position of applied methods, effectiveness and staging: systematic review

A systematic review was performed using the RSCI and PubMed databases, with the following search keywords: “accommodation”, “asthenopia”, “computer vision syndrome”, “quality of life”, “visual performance”. The sources were selected according to the criteria of prospective or retrospective studies. A total of 614 sources were analyzed with further use of the systematic review filters and the authors’ knowledge on the topic. To date, the following main patterns of diagnosing accommodative asthenopia (AA) in patients with visually-strained work (VSW): criteria related to objective (accommodography), subjective (quality of life), and ophthalmo-ergonomic parameters of the visual system; a personalized approach to AA diagnostics, considering habitual excess accommodation tension (HEAT) and asthenic form of accommodative asthenopia (AFAA) as separate functional disorders; a comprehensive approach to AA diagnostics, considering the occurrence of this disorder in combination with functional disorders of psychological adaptation, which are associated with the stressful nature of professional activity. Along with this, the following patterns of therapeutic and preventive measures for patients with VSW with AA phenomena are determined: the leading place is occupied by the effect of low-energy laser radiation and magnetophoresis, as well as optical-reflex training. The basis for adequate AA treatment is to determine the form of this functional disorder (PINA or AFAA). The choice of restorative treatment is based on the proposed methodological principles (personalization, complexity, consistency, standardization, repeatability), as well as time and amplitude parameters of the impact of physical factors on the accommodative system of the eye. To improve the effectiveness of restorative treatment of accommodative disorders in individuals with VSW with AA phenomena, a multidisciplinary syndrome-pathogenetic approach to the use of physical methods is necessary.

1. Tarutta E.P., Khubieva R.R., Markosyan G.A. Certain chorioretinal parameters of the eye in congenital and acquired myopia and their relationship with anatomical and optical parameters. Russian ophthalmological journal. 2021; 14 (3): 46—53 (In Russ.). https://doi.org/10.21516/2072-0076-2021-14-3-46-53

2. Tarutta E.P., Filinova O.B., Kvaratskhelia N.G., Toloraya P.P. Study of the habitual and autonomic tone of accommodation in children with myopia and hypermetropia. Vestnik oftal'mologii. 2010; 6: 18—21 (In Russ.).

3. Tarutta E.P., Tarasova N.A. Prognostic and diagnostic value of objective accommodative response. Russian pediatric ophthalmology. 2015; 1: 27—9 (in Russ.).

4. Tarutta E.P., Proskurina O.V., Tarasova N.A., Markosyan G.A. Analysis of risk factors that cause myopia in pre-school children and primary school students. Health Risk Analysis. 2019; 3: 26-33 (In Russ.). doi: 10.21668/health.risk/2019.3.03

5. Strakhov V.V., Klimova O.N., Korchagin N.V. The clinical picture of active accommodation for far vision. Russian ophthalmological journal. 2018; 11 (1): 42-51 (In Russ.). https://doi.org/10.21516/2072-0076-2018-11-1-42-51

6. Ranasinghe P, Wathurapatha WS, Perera YS, et al. Computer vision syndrome among computer office workers in a developing country: an evaluation of prevalence and risk factors. BMC Res Notes. 2016 Mar 9; 9: 150. doi: 10.1186/s13104-016-1962-1

7. Zalat MM, Amer SM, Wassif GA, El Tarhouny SA, Mansour TM. Computer vision syndrome, visual ergonomics and amelioration among staff members in a Saudi medical college. Int J Occup Saf Ergon. 2022 Jun; 28 (2): 1033-41. doi: 10.1080/10803548.2021.1877928

8. Lema AK, Anbesu EW. Computer vision syndrome and its determinants: A systematic review and meta-analysis. SAGE Open Med. 2022 Dec 9; 10: 20503121221142402. doi: 10.1177/20503121221142402

9. Long J, Cheung R, Duong S, Paynter R, Asper L. Viewing distance and eyestrain symptoms with prolonged viewing of smartphones. Clin Exp Optom. 2017 Mar; 100 (2): 133-37. doi: 10.1111/cxo.12453

10. Ovechkin I.G., Konovalov M.E., Leksunov O.G., Kovrigina E.I., Yudin V.E. The main subjective manifestations of computer vision syndrome. Russian ophthalmological journal. 2021; 14 (3): 83-7 (In Russ.). https://doi.org/10.21516/2072-0076-2021-14-3-83-87

11. Turkistani AN, Al-Romaih A, Alrayes M.M, et al. Computer vision syndrome among Saudi population: An evaluation of prevalence and risk factors. J Family Med Prim Care. 2021; 10 (6): 2313-18. doi: 10.4103/jfmpc.jfmpc_2466_20

12. Antona B, Barrio AR, Gasc0 Л, et al. Symptoms associated with reading from a smartphone in conditions of light and dark. Appl Ergon. 2018 Apr; 68: 12-7. doi: 10.1016/j.apergo.2017.10.014

13. Porcar E, Pons AM, Lorente A. Visual and ocular effects from the use of flatpanel displays. Int J Ophthalmol. 2016 Jun 18; 9 (6): 881-5. doi: 10.18240/ijo.2016.06.16

14. Assefa NL, Weldemichael DZ, Alemu HW, et al. Prevalence and associated factors of computer vision syndrome among bank workers in Gondar City, northwest Ethiopia, 2015. Clin Optom (Auckl). 2017; 10 (9): 67-76. doi: 10.2147/OPTO.S126366

15. Bogdănici CM, Săndulache DE, Nechita CA. Eyesight quality and computer vision syndrome. Rom J Ophthalmol. 2017; 61 (2): 112-16. doi: 10.22336/rjo.2017.21

16. Proskurina O.V., Tarutta E.P., Iomdina E.N., Strakhov V.V., Brzheskiy V.V. Current classification of asthenopia: clinical forms and stages. Russian ophthalmological journal. 2016; 9 (4): 69-73 (In Russ.). doi: 10.21516/2072-0076-2016-9-4-69-73

17. Katargina L.A., ed.Accommodation: a guide for doctors. Moscow: April, 2012 (In Russ.).

18. Ovechkin I.G., Gadzhiev I.S., Kozhukhov A.A., Belikova E.I. Diagnostic criteria for the asthenic form of accommodative asthenopia in patients with computer vision syndrome. Clinical ophthalmology. 2020; 20 (4): 169—74 (In Russ.). doi: 10.32364/2311-7729-2020-20-4-169-174

19. Makhova M.V., Strakhov V.V. Interaction of accommodative and subjective diagnostic criteria of accommodation disorders. Russian ophthalmological journal. 2019; 12 (3): 13-9 (In Russ.). https://doi.org/10.21516/2072-0076-2019-12-3-13-19

20. Lara F, Águila-Carrasco AJ, Marín-Franch I, et al. The effect of retinal illuminance on the subjective amplitude of accommodation. Optom Vis Sci. 2020; 97 (8): 641-47. doi: 10.1097/OPX.0000000000001544

21. Stokkermans TJ, Reitinger JC, Tye G, Kao CY, et al. Accommodative exercises to lower intraocular pressure. J Ophthalmol. 2020 Dec 18; 2020: 6613066. doi: 10.1155/2020/6613066

22. Mironov A.V., Ovechkin I.G. Comparative assessment of objective and subjective indicators of the accommodative system of the eye in individuals engaged in visually intense work. Modern Optometry. 2015; 6: 16-9 (In Russ.).

23. Kashif RF, Rashad MA, Said AMA, Rabie MA, Gomaa WA. Ultrasound biomicroscopy study of accommodative state in Smartphone abusers. BMC Ophthalmol. 2022 Aug 3; 22 (1): 330. doi: 10.1186/s12886-022-02557-x

24. Fernández-Vigo JI, Kudsieh B, Shi H, et al. Diagnostic imaging of the ciliary body: Technologies, outcomes, and future perspectives. Eur J Ophthalmol. 2022 Jan; 32 (1): 75-88. doi: 10.1177/11206721211031409

25. Aboumourad R, Anderson HA. Comparison of dynamic retinoscopy and autorefraction for measurement of accommodative amplitude. Optom Vis Sci. 2019 Sep; 96 (9): 670-77. doi: 10.1097/OPX.0000000000001423

26. Tarutta E.P., Aklaeva N.A., Tarasova N.A., Larina T.Yu., Kushnarevich N.Yu. Objective parameters of accommodation in concomitant strabismus. Vestnik oftal'mologii. 2019; 135 (6): 11-6 (In Russ.). https://doi.org/10.17116/oftalma201913506111

27. Tarutta E.P., Tarasova N.A., Markosyan G.A., Kushnarevich N.Yu., Larina T.Yu. An objective study of negative accommodation. Russian ophthalmological journal. 2019; 12 (1): 64-8 (In Russ.). https://doi.org/10.21516/2072-0076-2019-12-1-64-68

28. Tarutta E.P., Luzhnov P.V., Tarasova N.A., ct al. A new method for quantifying accommodation parameters based on objective dynamic accommodometry. Russian ophthalmological journal. 2024; 17 (2): 38-46 (In Russ.). https://doi.org/10.21516/2072-0076-2024-17-2-38-46

29. Ovechkin I.G., Gadzhiev I.S., Kozhukhov A.A., Belikova E.I. Diagnostic criteria for the asthenic form of accommodative asthenopia in patients with computer vision syndrome. Clinical ophthalmology. 2020; 20 (4): 169-74 (In Russ.). doi: 10.32364/2311-77292020-20-4-169-174

30. Ovechkin I.G., Yudin V.E., Kovrigina E.I., Budko A.A., Matvienko V.V. Methodological principles for the development of a questionnaire “Quality of Life” in patients with computer visual syndrome. Ophthalmology in Russia. 2021; 18 (4): 926-31 (In Russ.). https://doi.org/10.18008/1816-5095-2021-4-926-931

31. Seguí Mdel M, Cabrero-García J, Crespo A, Verdú J, Ronda E. A reliable and valid questionnaire was developed to measure computer vision syndrome at the workplace. J Clin Epidemiol. 2015 Jun; 68 (6): 662-73. doi: 10.1016/j.jclinepi.2015.01.015

32. Şahlı E, İdil ŞA. Comparison of quality of life questionnaires in patients with low vision. Turk J Ophthalmol. 2021 Apr 29; 51 (2): 83-88. doi: 10.4274/tjo.galenos.2020.99975

33. Belikova E.I., Gatilov D.V., Ovechkin N.I., Eskina E.N. Modern aspects of diagnosis and treatment of subjective manifestations and accommodation disorders in patients — professional users ofpersonal computers (systematic review). Russian medicine. 2023; 29 (3): 217-27 (In Russ.). doi: 10.17816/medjrf340800

34. Pokrovsky D.F., Medvedev I.B., Ovechkin N.I., Ovechkin I.G., Pavlov A.I. Comparative assessment of the dynamics of visual performance of a patient with visually intense work with binocular cataract after various technologies of cataract phacoemulsification. Ophthalmology in Russia. 2022; 19 (3): 603-8 (In Russ.). https://doi.org/10.18008/1816-5095-2022-3-603-608

35. Nowosielski Y, Leitner B, Rauchegger T, et al. Bilateral cataract surgery improves neurologic brake reaction time and stopping distance in elderly drivers. Acta Ophthalmol. 2021 Nov; 99 (7): e1013-17. doi: 10.1111/aos.14748

36. Huisingh C, Levitan EB, Irvin MR, et al. Visual sensory and visual-cognitive function and rate of crash and near-crash involvement among older drivers using naturalistic driving data. Invest Ophthalmol Vis Sci. 2017 Jun 1; 58 (7): 2959-67. doi: 10.1167/iovs.17-21482

37. Emelianov G.A. Basic patterns of occurrence of visual fatigue in a human operator of visually intense work without pathology of the organ of vision in modern conditions of professional activity. Military medical journal. 2013; 134 (1): 58-60 (In Russ.).

38. Emelianov G.A., Shakula A.V. Clinical and functional manifestations of psychological maladaptation in a human operator of visually intense work. Military medical journal. 2013; 334 (9): 71-3 (In Russ.).

39. Tarutta E.P., Iomdina E.N., Tarasova N.A. Nonsurgical treatment ofprogressive myopia. RMJ. Clinical ophthalmology. 2016; 4: 204-10 (In Russ.). doi: 10.21689/2311-7729-2016-16-4-204-210

40. Tarutta E.P., Tarasova N.A. Comparative evaluation of the effectiveness of various treatment modalities for accommodation disorders and acquired progressive myopia. Vestnik oftal'mologii. 2015; 131 (1): 24-9 (In Russ.). https://doi.org/10.17116/oftalma2015131124-28

41. Yudin V.E., Yaroshenko V.P., Belikova E.I., et al. Methodological principles of medical rehabilitation of patients with visually strenuous work with the symptoms of accommodative asthenopia after excimer laser correction of myopia. Bulletin of the medical institute of continuing education. 2023; 3 (2): 64-9 (In Russ.). doi 10.36107/2782-1714_2023-3-2-64-69

42. Ovechkin I.G., Yudin V.E., Emel'yanov G.A., Mironov A.V. Multidisciplinary approach to the correction of accommodation refraction disorders in visually intensive labor persons. Ophthalmology in Russia. 2015; 12 (2): 68-73 (In Russ.). https://doi.org/10.18008/1816-5095-2015-2-68-73

43. Shakula A.V., Emelianov G.A., Ovechkin I.G. Methods of medical rehabilitation of patients with visually intense work and socially significant disorders of psychological adaptation. Bulletin of restorative medicine. 2013; 6: 74-9 (In Russ.).

44. Ovechkin I.G., Yudin V.E., Mironov A.V., Emelianov G.A. Correction of accommodative-refractive disorders in persons engaged in visually intense work from the standpoint of modern methods of physical influence. Modern optometry. 2015; 5: 24-8 (In Russ.).

45. Ovechkin I.G., Yudin V.E., Mironov A.V., Emelianov G.A., Azarova E.K. Application of cranial osteopathic therapy in complex treatment of accommodation-refractive disorders in patients with visually-intense work. Cataract and refractive surgery. 2015; 15 (2): 52-3 (In Russ.).

46. Drakon A.K., Korchazhkina N.B. Application of automated perimetry to assess the effect of magnetic therapy in patients with primary open-angle glaucoma. Functional diagnostics. 2011; 3: 108-9 (In Russ.).

47. Korchazhkina N.B., Katsnelson V.V, Drakon A.K. Combined use of transcranial magnetic therapy with a running reverse magnetic field and synchronized ophthalmochromotherapy to improve cognitive abilities in combat athletes with peripheral retinal dystrophies. Kremlin medicine. Clinical bulletin. 2018; 1: 171-4 (In Russ.). https://kremlin-medicine.ru/index.php/km/article/view/1074

48. Rychkova S.I., Likhvantseva V.G. Results of using different modes of presentation of stereostimuli in the study of stereo vision in normal children and in children with non-paralytic strabismus without functional scotoma. Ophthalmology in Russia. 2021; 18 (2): 296-308 (In Russ.). https://doi.org/10.18008/1816-5095-2021-2-296-308

49. Fan Q, Xie J, Dong Z, Wang Y. The effect of ambient illumination and text color on visual fatigue under negative polarity. Sensors (Basel). 2024 May 30; 24 (11): 3516. doi: 10.3390/s24113516

50. Valter K, Tedford SE, Eells JT, Tedford CE. Photobiomodulation use in ophthalmology - an overview of translational research from bench to bedside. Front Ophthalmol (Lausanne). 2024 Aug 15; 4: 1388602. doi: 10.3389/fopht.2024.1388602

51. Ignatiev S.A. Visual fatigue when working with video display terminals and modern methods of its prevention. Moscow: Mick; 2013. (In Russ.).

52. Shapovalov S.L., Milyavskaya T.I., Ignatiev S.A. The main forms of asthenopia. Moscow: Mick; 2012 (In Russ.).

53. Ovechkin I.G., Gadzhiev I.S., Kozhukhov A.A., Belikova E.I. Optical reflex treatment of myopia and asthenic form of accommodation asthenopia form the standpoint of the methods used, effectiveness and staging. Ophthalmology in Russia. 2020; 17 (3): 422-8 (In Russ.). https://doi.org/10.18008/1816-5095-2020-3-422-428

54. Ovechkin I.G., Yudin V.E., Gadzhiev I.S., Kozhukhov A.A., Belikova E.I. Diagnostics and comprehensive recovery treatment of an astenic form of accommodative astenopia in an asteno-neurotic state of psychosomatic genesis. A clinical case. Russian ophthalmological journal. 2020; 13 (4): 83-6 (In Russ.). https://doi.org/10.21516/2072-0076-2020-13-4-83-86

55. Khandzhyan A.T., Tarutta E.P., Khodzhabekyan N.V., Khrabrova M.A. Can the progression of myopia be restrained by monolateral excimer laser correction? Russian ophthalmological journal. 2020; 13 (3): 56-60 (In Russ.). https://doi.org/10.21516/2072-0076-2020-13-3-56-60

56. Belikova E.I., Gatilov D.V., Ovechkin I.G., Eskina E.N. Dynamics of accommodative asthenopia in patients with visually intense work with different degrees of myopia after LASIK. Ophthalmology in Russia. 2023; 20 (3): 479-84 (In Russ.). https://doi.org/10.18008/1816-5095-2023-3-479-484

57. Allen PM, Radhakrishnan H, Rae S, et al. Aberration control and vision training as an effective means of improving accommodation in individuals with myopia. Invest Ophthalmol Vis Sci. 2009 Nov; 50 (11): 5120-9. doi: 10.1167/iovs.08-2865

58. Vasudevan B, Ciuffreda KJ, Ludlam DP. Accommodative training to reduce nearwork-induced transient myopia. Optom Vis Sci. 2009 Nov; 86 (11): 1287-94. doi: 10.1097/OPX.0b013e3181bb44cf

59. Allen PM, Charman WN, Radhakrishnan H. Changes in dynamics of accommodation after accommodative facility training in myopes and emmetropes. Vision Res. 2010 May 12; 50 (10): 947-55. doi: 10.1016/j.visres.2010.03.007