Accommodative dysfunction in children presenting with nonorganic visual loss: a retrospective case series

To characterize binocular visual function in pediatric NOVL and evaluate its response to short-term accommodative suppression. In this retrospective case-control study, 22 children diagnosed with NOVL were enrolled and compared with age- and refractive error-matched healthy controls. Participants underwent optical coherence tomography (OCT), electroretinography (ERG), visual evoked potentials (VEP), microperimetry, and comprehensive binocular visual function testing. NOVL patients received topical tropicamide for 7 consecutive days and were reassessed on day 8 and at the final follow-up visit. Baseline LogMAR best-corrected visual acuity (BCVA) was 0.40 (0.28–0.52) in the NOVL group and 0.00 (0.00–0.00) in the control group. Structural and sensory pathway evaluations showed no significant differences between groups. Compared with controls, the NOVL group demonstrated reduced accommodative amplitude ( P = 0.003), increased AC/A ratio ( P = 0.002), and greater near exophoria ( P = 0.004). On day 8 after intervention, BCVA improved to 0.00 (0.00–0.10) ( P < 0.001), while spherical equivalent remained unchanged ( P = 0.685). Visual acuity remained stable during follow-up. These findings suggest that visual impairment in a subset of children with NOVL may arise from dysregulation within accommodative-convergence control networks rather than sensory pathway deficits.