Nutritional Optometry

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· Habitual Accommodative Stimulus Stress

· Diet

· Reducing the Accommodative Stimulus

· Functional Photophobia

· Complete Listing of Abstracts

· Glossary

Habitual Accommodative Stimulus Stress

"Subjects who habitually engaged themselves in long hours of daily repeated, sustained closework with substantial accommodative stimulus stress because of a lack of an intrinsic plus dioptric add (––an intrinsic add as in uncompensated myopia––) or lack of an extrinsic add (as in reading glasses) either

(a) suffer time-indexed deterioration of binocular fusion and coordination as measured in terms of a Binocular Convergence Variance scoring protocol

AND

(b) experience time-indexed depression in discomfort-glare threshold

(c) retain binocular coordination, but adaptively develop significant elevation of IOP and increasing myopia or decreasing hyperopia."

Accommodative Stimulus Diopter Hours & Vision Deterioration (PDF)

"…most functionally photophobic students are the ones experiencing the greatest number of diopter-hours of daily detailed closework accommodation, and that they are caught up in an accommodative fatigue syndrome including increase in diameter and depth of suppression and increasing variability of binocular convergence. [Lane's 1963 study of 79 findings for 100 patients had revealed that the depth of photophobia was positively time indexedand strongly associated with Skeffington and associates seven stage syndrome of binocular deterioration.]"

The Functional Photophobia Syndrome and Binoculart Fusion in Neuro-Rehabilitation (PDF)

Formula

Habitual accommodative stimulus stress is determined by the

log10 {estimated average daily closework time involvement in hours}

{

[the inverse of the working distance measured in meters]

minus

[the total dioptric power for the controlling eye of any prosthetic lens minus the spherical-equivalent bestacuity subjective refractive power of the controlling eye]

}

Accommodative Stimulus Diopter Hours & Vision Deterioration (PDF)

Diet

Vision Therapy vs. Diet

"Age-for-age, unless countered by vision therapy

accommodative training, accommodative stimulus stress in teens and adults is a more significant risk factor for predicting myopic increase than the dietary risk factors…"

Diopter Hours of Accommodative Stimulus, Ciliary Muscle Fuel Accession, Scleral Distension Risk Factors, and Myopiagenesis (PDF)

Posture vs. Diet

"…Despite these measurements and our own evidence for the importance of restriction of supplemental sugar in the diet, we find that postural shifts which can and do result in unequal accommodative stimuli and even central-vision suppression can often promote larger change than the dietary factors which according to one commonly held theory should affect both eyes more or less equally."

Diopter Hours of Accommodative Stimulus, Ciliary Muscle Fuel Accession, Scleral Distension Risk Factors, and Myopiagenesis (PDF)

"In untrained individuals, poor posture scores are more common in those with higher intake ratios of refined CHOs relative to complex CHOs."

Accommodative Stimulus Diopter Hours & Vision Deterioration (PDF)

Diet, Fatigue, and Myopia

"…A fatigue syndrome in response to frequently repeated long-sustained stimulus to accommodation appears to be the principal trigger to myopiagenesis. Dietary factors affect both the distensibility of the globe and the ability, age-for-age, to support strong or long-sustained binocular accommodation without fatigue. Except in marasmus and in nuclear cataractogenesis, dietary factors appear to control the magnitude of the refractive change rather than initiating the change."

Diopter Hours of Accommodative Stimulus, Ciliary Muscle Fuel Accession, Scleral Distension Risk Factors, and Myopiagenesis (PDF)

Accommodation and Chromium/Vanadium Ratio

"Lane previously reported highly significant chromium/vanadium ratio depression indexed in nape hair of myopes, associated with depressed accommodation."

"…Foods rich in Cr include most unprocessed naturally sweet or starchy foods. Cr-rich foods are high calorie, best when unrefined. Foods too rich in vanadium include chocolate, kelp, mushrooms, most U.S. chow-fed poultry, and seafood larger than herring."

High Myopes are Biochemically Different from High Hyperopes (PDF)

Nutrition (in general)

"…Relationships are easier to see when we control for nutriture status, including concentrations of red-blood-cell chromium and vanadium, tissue and dietary calcium in ratio to phosphorus, and to dietary intake of food folate, total intake of ascorbic acid, and the ratio of supplemental sugar and refined carbohydrates (CHOs) to total CHO intake.

Accommodative Stimulus Diopter Hours & Vision Deterioration (PDF)

Reducing the Accommodative Stimulus

"…The primary approach for prevention and reversal of the myopiagenesis process needs to place increased emphasis on strengthening the accommodative response ability and reducing the accommodative stimulus through ergonomics, vision therapy, appropriate use of lenses, nutrition, blood exchanges, and modified study habits."

Diopter Hours of Accommodative Stimulus, Ciliary Muscle Fuel Accession, Scleral Distension Risk Factors, and Myopiagenesis (PDF)

Functional Photophobia

What is Functional Photophobia?

“Functional photophobia is the most commonly encountered form of glare hypersensitivity in the United States, and it is an important clinical problem in ophthalmic practice. It produces discomfort more usually than pain, and much (but not all) of what is considered ‘discomfort glare’ may be attributed to functional photophobia.”

The Functional Photophobia Syndrome and Binocular Fusion in Neuro-Rehabilitation (PDF)

“…Described by Lane (1963) as associated with what Kaufman (1963) has called ‘variability [or variation] of binocular convergence.’”

The Functional Photophobia Syndrome and Binocular Fusion in Neuro-Rehabilitation (PDF)

Symptoms

“For example, the functional photophobe has developed aversive behaviors that have the value of protecting the individual from fusion-degrading stresses created by the large fields of high luminance that he or she cannot manage binocularly.”

The Functional Photophobia Syndrome and Binocular Fusion in Neuro-Rehabilitation (PDF)

“Secondly, by reducing the retinal illuminance with severe wincing or by closing or virtually closing one eye, the functional-photophobia response enables performance under conditions beyond the individual’s range of binocular wide-open-eye ability.”

The Functional Photophobia Syndrome and Binocular Fusion in Neuro-Rehabilitation (PDF)

Stages of Photophobia

· “Stage PP-Zero = no apparent hypersensitivy;

· Stage PP-1 = Newly experienceed, usually shortlived hypersensitivity to extremely bright outdoors sun illuminating large, bright peripheral-field walls and pavements and other surfaces;

· Stage PP-2 = Chronic hypersensitivity even and especially to hazy-bright skies;

· Stage PP3 = Usually many years of hypersensitivity resulting in great discomfort in supermarkets where the whole ceiling is brightly illuminated;

· Stage PP4: The final stage of a long chain of decreasing binocular vision skills or a degenerative chain institued by trauma, characterized by intolerance even to usual relatively low levels of illumination used in home lighting.”

The Functional Photophobia Syndrome and Binocular Fusion in Neuro-Rehabilitation (PDF)

Causes

“Further, we have evidence at the 0.001 level that the most functionally photophobic students are the ones experiencing

· The greatest number of diopter-hours of daily detailed closework accommodation, and that they are caught up in an

· Accommodative fatigue syndrome including increase in diameter and depth of suppression and increasing variability of binocular convergence.”

The Functional Photophobia Syndrome and Binocular Fusion in Neuro-Rehabilitation (PDF)

Diagnosis

“It is easy to demonstrate that this is a functional photophobia––a dramatic manifestation of binocularity, strikingly relieved by covering one eye.”

The Functional Photophobia Syndrome and Binocular Fusion in Neuro-Rehabilitation (PDF)

Studies

Description

“As part of this study a functional binocular facilitation syndrome of photophobic response was documented using simultaneous

· video-recording,

· electro oculography (EOG),

· galvanic skin response (GSR) and

· tests of binocular and accommodative function, correlated with subjective report and a 141-item preliminary questionnaire.

Functional photophobia was elicited in 87.5% of students, ages 18-35, by

· Confronting them with a 120°-wide peripheral vision field of high luminance, averaging 3.2 x 104 cd/m2 over a large area,

· Surrounding a 34° dark-appearing center––

producing photophobia when viewed binocularly and no photophobia when viewed monocularly.”

The Functional Photophobia Syndrome and Binocular Fusion in Neuro-Rehabilitation (PDF)

Conclusions

“Three basic relations [relationships] were discovered for the functional-photophobia responding subjects in this study:

(1)…[Accommodative Stress Index correlates strongly with functional photophobia threshold …]

(2)…central suppression zone diameter… variation of binocular convergence… is predictive of… ‘accommodative stress index’…

(3) Low ratios of Palpebral Fissure-to-Corneal Diameter (PF:CD) are associated with high scores on the ‘accommodative-stress index,’ and high ratios of PF:CD are associated with low levels of accommodative stress...”

The Functional Photophobia Syndrome and Binocular Fusion in Neuro-Rehabilitation (PDF)

Treatment

Types of Photophobia

“The distinctions between the

· Traumatized-eye photophobia,

· The nutritionally deprived photophobia, and

· The behaviorally defined five stages of functional photophobia

are important to evaluate in the neuro-rehab patient to aid in the programming of therapy.”

The Functional Photophobia Syndrome and Binocular Fusion in Neuro-Rehabilitation (PDF)

Reversibility

“The earlier studies by Lane cited above documented the reversibility of this deteriorative syndrome with

· low plus adds [lenses] (+0.25 to +1.25 in young adults) and

· occasionally low-plus fitover (clip-on) therapy lenses, but especially with the use of VT [vision therapy].”

The Functional Photophobia Syndrome and Binocular Fusion in Neuro-Rehabilitation (PDF)

Tinted Lenses

“Tinted lenses

· Enable performance in persons with otherwise fragile binocular fusion and especially in periodic or intermittent exotropes [deviating eye turns outward], but

· May not be treating the underlying accommodative fatigue syndrome, except when the tint creates the effect of a small plus add.”

The Functional Photophobia Syndrome and Binocular Fusion in Neuro-Rehabilitation (PDF)