RESUMEN
INTRODUCTION: There is scientific evidence that an individual's beliefs and/or expectations play a role in the behavioural and physiological response to a given treatment. This study aimed to assess whether the dynamics of the accommodative response and stereoacuity are sensitive to experimentally induced placebo and nocebo effects. METHODS: Nineteen healthy university students performed three experimental sessions (placebo, nocebo and control) in randomised order, with the dynamics of the accommodative response (magnitude and variability), stereoacuity and subjective measures being assessed in all sessions. For the experimental manipulation, participants ingested an inert capsule that was alleged to have positive (white capsule, placebo condition) or negative (yellow capsule, nocebo conditions) effects on the human physiology. In the control condition, participants did not ingest a capsule. RESULTS: The data revealed that the variability of accommodation was sensitive to experimentally induced placebo and nocebo effects, showing a more stable accommodative response for the placebo compared with the nocebo condition (corrected p-value = 0.04, Cohen's d = 0.60). In addition, better stereoacuity was found with the placebo, compared with the nocebo (corrected p-value = 0.01, Cohen's d = 0.69) and control (corrected p-value = 0.03, Cohen's d = 0.59) conditions. Successful experimental manipulation was confirmed by the analysis of subjective perceptions. CONCLUSIONS: These findings provide evidence that manipulating expectations about the efficacy of an inert treatment affect the dynamics of the accommodative response (variability of accommodation) and stereoacuity. The results have important applications in both clinical and research outcomes, where individuals´ beliefs/expectations could modulate the visual function.
Asunto(s)
Efecto Nocebo , Optometría , Acomodación Ocular , Humanos , Agudeza VisualRESUMEN
The present study was aimed at assessing the impact of manipulating the attentional load using a multiple object tracking (MOT) task on the dynamics of the accommodative response in children with attention deficit hyperactivity disorder (ADHD). The pupil size was recorded to assess the effectiveness of the experimental manipulation, and the role of ADHD medication was also explored. The accommodative and pupil dynamics (magnitude and variability) were monitored with an open-field autorefractometer (WAM-5500) in 41 children with ADHD (24 non-medicated and 17 medicated) and 21 non-ADHD controls, while they performed the MOT task with four different levels of complexity (i.e., tracking zero, one, two, or three targets). We found that increasing the attentional load caused a heightened accommodative response, showing a negative association between MOT complexity and accommodative lag in children with ADHD and non-ADHD controls. Complementarily, the pupil size increased as a function of task complexity, confirming a successful experimental manipulation. The stability of accommodation was insensitive to the attentional manipulation, but it differed between groups. Specifically, non-medicated children with ADHD exhibited a greater variability of accommodation in comparison to controls. Increasing the attentional load is associated with a reduction in the accommodative lag in children with ADHD and controls. Our findings show that the allocation of attention plays an important role in the dynamics of the accommodative response, which may be of relevance in the diagnosis and treatment of accommodative deficits in children with and without ADHD.
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Trastorno por Déficit de Atención con Hiperactividad , Acomodación Ocular , Niño , Humanos , PupilaRESUMEN
BACKGROUND: There are claims that ocular accommodation differs in children with attention deficit hyperactivity disorder (ADHD) compared to typically developing children. We examined whether the accommodation response in ADHD children is influenced by changing the stimulus to accommodation in an attempt modify the level of attentional engagement or by medication for the condition. METHODS: We measured the accommodative response and pupil diameter using a binocular, open-field autorefractor in non-medicated and medicated children with ADHD (n = 22, mean age = 10.1 ± 2.4 years; n = 19; mean age = 11.0 ± 3.8 years; respectively) and in an age-matched control group (n = 22; mean age = 10.6 ± 1.9 years) while participants were asked to maintain focus on (i) a high-contrast Maltese cross, (ii) a frame of a cartoon movie (picture) and (iii) a cartoon movie chosen by the participant. Each stimulus was viewed for 180 s from a distance of 25 cm, and the order of presentation was randomised. RESULTS: Greater lags of accommodation were present in the non-medicated ADHD in comparison to controls (p = 0.023, lags of 1.10 ± 0.56 D and 0.72 ± 0.57 D, respectively). No statistically significant difference in the mean accommodative lag was observed between medicated ADHD children (lag of 1.00 ± 0.44D) and controls (p = 0.104) or between medicated and non-medicated children with ADHD (p = 0.504). The visual stimulus did not influence the lag of accommodation (p = 0.491), and there were no significant group-by-stimulus interactions (p = 0.935). The variability of accommodation differed depending on the visual stimulus, with higher variability for the picture condition compared to the cartoon-movie (p < 0.001) and the Maltese cross (p = 0.006). In addition, the variability yielded statistically significant difference for the main effect of time-on-task (p = 0.027), exhibiting a higher variability over time. However, no group differences in accommodation variability were observed (p = 0.935). CONCLUSIONS: Children with ADHD have a reduced accommodative response, which is not influenced by the stimulus to accommodation. There is no marked effect of medication for ADHD on accommodation accuracy.
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Acomodación Ocular/fisiología , Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Inhibidores de Captación de Dopamina/uso terapéutico , Metilfenidato/uso terapéutico , Trastornos de la Visión/fisiopatología , Visión Binocular/fisiología , Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Niño , Femenino , Humanos , Masculino , Pupila/fisiología , Agudeza Visual/fisiologíaRESUMEN
Aniseikonia has demonstrated to deteriorate the binocular function, however its impact on the accommodative response remains unknown. The present study aimed to analyze the effects of artificially-induced aniseikonia, using afocal magnifiers, on the dynamics of the accommodative response. The magnitude and variability of the accommodative response were objectively measured in 20 young healthy subjects by a binocular open-field autorefractometer. Participants observed a static stimulus for 90â¯s, under seven degrees of aniseikonia (0%, 1%, 3%, 5%, 8%, 10% and 12%), and at three distances (500â¯cm, 40â¯cm and 20â¯cm). Complementarily, near stereoacuity, and perceived levels of fatigue and visual discomfort were assessed. The degree of induced aniseikonia was associated with the magnitude of the accommodative response (pâ¯<â¯0.001, ηp2â¯=â¯0.329), obtaining a statistically significant reduced accommodative lag for the induced aniseikonia conditions of 8%, 10% and 12% in comparison to the control condition at 40â¯cm (p-correctedâ¯=â¯0.019, <0.001 and 0.013, respectively) and at 20â¯cm (p-correctedâ¯<â¯0.001, <0.001 and 0.003, respectively). However, the degree of induced aniseikonia did not reveal any effect on the variability of accommodation (pâ¯>â¯0.05). We also found a decline in near stereoacuity and an increment of visual symptomatology when inducing aniseikonia (pâ¯<â¯0.05). Our data evidenced that greater degrees of induced aniseikonia cause a heightened accommodative response. These preliminary findings may be of relevance for patients undergoing cataract or refractive surgery procedures in which aniseikonia can be induced.