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Purpose <p>Early-onset primary angle-closure disease (EOPACD), defined by onset before 40 years of age, is associated with a thicker and more anteriorly positioned crystalline lens and a crowded anterior segment, which may alter accommodative performance. This study aimed to compare accommodative function and near-addition requirements in EOPACD with those in age-matched healthy controls, and to assess the relationship between anterior segment biometry and accommodative outcomes.</p> Methods <p>This prospective case-control study compared unrelated EOPACD patients with healthy controls. Multiple clinical parameters pertaining to the refractive apparatus of the eye, including refraction, amplitude of accommodation (AA), negative relative accommodation (NRA), positive relative accommodation (PRA) and near-addition, were assessed using standardised clinical methods. Group differences were analysed using linear regression with cluster-robust standard errors, both unadjusted and adjusted for age, sex and refractive error, with marginal means and effect sizes reported.</p> Results <p>A total of 164 eyes, including 85 EOPACD and 79 controls, from 90 unrelated participants were analysed. The groups were comparable in age (<i>p</i> = 0.37). Eyes with EOPACD demonstrated a higher AA than controls in both unadjusted analyses (6.59 D [95% CI: 5.89–7.28] vs. 5.51 D [5.06–5.96]; <i>p</i> = 0.01) and adjusted analyses (6.50 D [5.93–7.10] vs. 5.60 D [5.12–6.10]; <i>p</i> = 0.02, Cohen’s <i>d</i> = 0.50). The near-addition requirement was significantly lower in EOPACD eyes in both unadjusted (0.61 D [0.44–0.78] vs. 0.91 D [0.76–1.05]; <i>p</i> = 0.01) and adjusted models (0.63 D [0.49–0.76] vs. 0.89 D [0.76–1.03]; <i>p</i> = 0.009, Cohen’s <i>d</i> = 0.61). NRA, PRA and best-corrected distance visual acuity did not differ significantly between groups.</p> Conclusions <p>Eyes with EOPACD demonstrated preserved or enhanced AA and reduced near-addition demand compared with age-matched healthy eyes. These findings are more supportive of a relative optical advantage related to the anterior segment configuration.</p>

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Accommodative Demand and Near Addition in Early-Onset Primary Angle-Closure Disease: A Comparative Study

  • 期刊论文

  • 发表日期：

    2026年6月1日

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  • Suresh Kumar Yadav,
  • Arnav Panigrahi,
  • Anand Kumar Pathak,
  • Nishtha Singh,
  • Sonika Singh,
  • Sumit Kumar Das,
  • Viney Gupta

摘要

Purpose

Early-onset primary angle-closure disease (EOPACD), defined by onset before 40 years of age, is associated with a thicker and more anteriorly positioned crystalline lens and a crowded anterior segment, which may alter accommodative performance. This study aimed to compare accommodative function and near-addition requirements in EOPACD with those in age-matched healthy controls, and to assess the relationship between anterior segment biometry and accommodative outcomes.

Methods

This prospective case-control study compared unrelated EOPACD patients with healthy controls. Multiple clinical parameters pertaining to the refractive apparatus of the eye, including refraction, amplitude of accommodation (AA), negative relative accommodation (NRA), positive relative accommodation (PRA) and near-addition, were assessed using standardised clinical methods. Group differences were analysed using linear regression with cluster-robust standard errors, both unadjusted and adjusted for age, sex and refractive error, with marginal means and effect sizes reported.

Results

A total of 164 eyes, including 85 EOPACD and 79 controls, from 90 unrelated participants were analysed. The groups were comparable in age (p = 0.37). Eyes with EOPACD demonstrated a higher AA than controls in both unadjusted analyses (6.59 D [95% CI: 5.89–7.28] vs. 5.51 D [5.06–5.96]; p = 0.01) and adjusted analyses (6.50 D [5.93–7.10] vs. 5.60 D [5.12–6.10]; p = 0.02, Cohen’s d = 0.50). The near-addition requirement was significantly lower in EOPACD eyes in both unadjusted (0.61 D [0.44–0.78] vs. 0.91 D [0.76–1.05]; p = 0.01) and adjusted models (0.63 D [0.49–0.76] vs. 0.89 D [0.76–1.03]; p = 0.009, Cohen’s d = 0.61). NRA, PRA and best-corrected distance visual acuity did not differ significantly between groups.

Conclusions

Eyes with EOPACD demonstrated preserved or enhanced AA and reduced near-addition demand compared with age-matched healthy eyes. These findings are more supportive of a relative optical advantage related to the anterior segment configuration.