Is Residual Accommodation Masking True Myopia Progression? Insights from Dynamic Accommodation Analysis

Purpose Understanding the mechanisms of dynamic accommodation is essential for improving the understanding and management of progressive myopia. This study compared dynamic and residual accommodation patterns between stable and progressive myopes.Methods Accommodative response, residual accommodation, microfluctuations, and response times were assessed in 18 myopic participants classified as stable (n = 10) or progressive (n = 8). Measurements were obtained in the relaxed state and during/after 1.00D, 2.45D, and 4.73D stimuli using a real-time Shack–Hartmann aberrometer.Results Progressive myopes showed higher residual accommodation after 2.45D (p = 0.014) and 4.73D (p = 0.008), a pattern not observed in stable myopes. They also exhibited greater accommodative instability, with significantly increased microfluctuations during 4.73D stimulus (p = 0.001). Regarding residual accommodation, microfluctuations increased after removal of the 1.00D and 2.45D stimuli in both stable (p = 0.008; p = 0.032) and progressive myopes (p = 0.002; p = 0.016), although values after 2.45D were significantly higher in progressive myopes than in stable myopes (p = 0.042). Progressive myopes also showed longer disaccommodative response time after the 2.45D stimulus (p = 0.032).Conclusions Although accommodative responses during stimulation were similar between stable and progressive myopes, residual accommodation, microfluctuations, and disaccommodative response times differed between groups and may represent relevant factors in progressive myopia.