title: Accommodative response/stimulus by dynamic retinoscopy:  near add guidelines.
abstract: OBJECTIVE
  Monocular estimation method (MEM) dynamic retinoscopy and low neutral (LN) dynamic retinoscopy are common procedures for evaluating the need for near-point plus adds for improved near-point performance in non-presbyopes. A combination of MEM and LN has been suggested to be a method of plotting accommodative response/accommodative stimulus functions and evaluating guidelines for prescribing from MEM.
  
  
  METHODS
  Using a combined MEM-LN procedure, MEM was performed on 80 young adults at 40 cm, with distance correction and with plus adds in 0.25 D steps up to and including +2.00 D. Modified Thorington dissociated phorias were also performed with each of the plus adds. Subjects picked a preferred add, which subjectively made print easiest and most comfortable to read.
  
  
  RESULTS
  The mean preferred add was +0.58 D over the distance prescription. The add derived from subtracting 0.25 D from the lag of accommodation with distance correction averaged 0.10 D more plus than the preferred add. The add at which dynamic retinoscopy showed a "with" motion of 0.25 D averaged 0.54 more plus than the preferred add. The add at which dynamic retinoscopy showed a "with" motion of 0.50 D averaged 0.16 more plus than the preferred add.
  
  
  CONCLUSIONS
  Adds derived from subtracting 0.25 D from the lag with distance correction and from finding the add that yields 0.50 D of "with" motion compared favorably with the preferred adds on average, but the standard deviations of the differences were high. Those guidelines could be reasonable starting points for the prescription of near-point plus adds for non-presbyopes, but follow-up testing to confirm or adjust add power would be advisable in the clinical setting.
authors.affiliation: School of Optometry, Indiana University, Bloomington, Indiana 47405, USA. dgoss@indiana.edu
authors.forename: David A
authors.initials: DA
authors.lastname: Goss
authors.forename: Sania
authors.initials: S
authors.lastname: Rana
authors.forename: Julie
authors.initials: J
authors.lastname: Ramolia
mesh_terms: D000065:Accommodation, Ocular / Q000502:physiology*; D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D012029:Refraction, Ocular / Q000502:physiology*; D042262:Retinoscopy / Q000379:methods / Q000592:standards*; D014792:Visual Acuity; D055815:Young Adult