Title Prevalence of Accommodative Insufficiency in a College-Age Student Population in Iran

Purpose: To determine the prevalence of accommodative insufficiency (AI) and its relation with age, gender, and refractive errors in a college-age student population in Iran.Methods: The present study was conducted cross-sectionally in 2017. All students had optometric tests including measurement of visual acuity, objective and subjective refraction, as well as binocular vision and accommodative examinations. Amplitude of accommodation was measured with the Donders’ push-up method using the Royal AirForce (RAF) rule. Monocular accommodative facility was measured with ±2.00 diopter flipper lenses. The accommodative response was tested using dynamic retinoscopy with the monocular estimation method (MEM). Results: The prevalence of AI in the studied population was 4.07% (95%CI: 2.61-5.52). The rate was 6.04% (95%CI: 3.58-8.50) in females and 2.01% (95%CI: 0.53-3.48) in males, and logistic regression showed a significantly higher odds of AI in females (OR=3.14, 95%CI: 1.33-7.45, p-value=0.009). The prevalence of AI was 2.59% (95%CI: 0.55-7.56) in the 18-19-year-old age group and 4.08% (95%CI: 0.09-8.07) in the 24-25-year-old group (p-value=0.848). The prevalence of AI among emmetropic, myopic, and hyperopic individuals was 3.74% (95% CI: 1.88-5.61), 4.44% (95%CI: 2.07-6.81), and 5.26% (95%CI: 4.79-16.32), respectively (p-value =0.869). In the multiple regression model, only gender showed significant relationship with AI (Odds ratio=3.14 95%CI: 1.33- 7.45; p-values=0.009). Conclusion: The prevalence of AI in the present study is lower than the most prevalence rates reported in previous studies. In the present study, gender and AI showed a strong association, such that AI prevalence was significantly higher in females than males.