The Effect of Accommodation on Ocular Shape

Purpose. Ocular shape is altered in myopia, and accommodation during nearwork is a proposed risk factor for myopia. Using relative peripheral refractive error (RPRE), ocular shape was assessed before, during, and after a period of sustained nearwork to determine whether accommodation affects ocular shape. Methods. Measurements of RPRE at 30° in the nasal visual field were obtained using the spherical equivalent calculated from Canon R‐1 autorefraction. The RPRE of 41 young adults was measured on two separate occasions separated by at least 1 week to assess RPRE repeatability. Later, the RPRE of 22 young adults was measured at a 0 D accommodative stimulus and then at a 3 D stimulus level at 0, 1, and 2 h during which subjects performed sustained nearwork at 33 cm. After 2 h of nearwork, subjects had RPRE measured at prescribed time intervals over a 1‐h period in which they looked in the distance (0 D stimulus). Results. The measurement of RPRE had adequate repeatability (mean difference ± SD, −0.05 ± 0.35 D) with ±0.68 D as the 95% limits of agreement. The onset of accommodation produced an immediate hyperopic shift of RPRE relative to baseline (+0.37 ± 0.44 D; p = 0.0007), indicating that ocular shape had become more prolate. This shape remained unchanged after 1 h of sustained accommodation (RPRE difference from baseline, +0.25 ± 0.55 D; p = 0.04) and then returned to baseline dimensions after 2 h of accommodation (RPRE difference from baseline, +0.11 ± 0.39 D; p = 0.21). At the 0 D stimulus level one minute after the period of nearwork, RPRE became more myopic relative to baseline (RPRE difference from baseline, −0.28 ± 0.50 D; p = 0.016). Ocular shape returned to baseline dimensions after 45 min of accommodative relaxation. Conclusions. Accommodation induced the ocular shape to become more prolate. The opposite occurred after accommodation was relaxed, namely a change toward a more oblate ocular shape. The transient nature of these changes suggests that tension on the choroid and choroidal hysteresis may play a role in influencing ocular shape.