This study highlights mismanagement in glass prescription in optometry care services and the importance of modified fogging technique (Borish’s delayed subjective refraction) to detect latent hyperopia, especially those patient age group of (30-35 years) associated with prolonged near work followed by asthenopia symptoms and near vision blur. This retrospective case series study was done at a tertiary care eye hospital in Uttar Pradesh, India. Thirty patients, presented with complaints of blurring of vision specially near work and asthenopic symptoms with history of aggravation of symptoms with prolonged near work (ill sustained of accommodation). Refraction was initially showing hyperopic refractive error but it was ignored  view of  vision was 20/20-20/25 for distance  but found to be gross near vision difficulty (N18), simple near  addition was prescribed. To prove mismanagement in Optometry care, a simple / modified fogging technique was introduced and was performed over the same patient. After this technique there was noted latent hyperopia and VA was 20/20 for distance with near vision N6 without any near add found. Diagnosis of latent hyperopia was made. Single glasses for distance were prescribed. Patients were observed after 2 months in which none had recurrence.  The condition resolved and asthenopic symptoms were improved.

Keywords: Latent hyperopia, Boris’s delayed subjective test, Ill sustained of accommodation.

1. Bruce AS, Atchison DA, Bhoola H. 1995. Accommodative convergence and age. Invest Ophthalmol Vis Sci 36:406-413.
2. Ciuffreda KJ, Rosenfield M, Chen HW 1997. The AC/A ratio, age and presbyopia. Ophthalmic Physiol Opt 17:307-315.
3. Rosenfield M, Ciuffreda KJ, Chen HW 1995. Effect of age on the interaction between the AC/A and CAlC ratios. Ophthalmic Physiol Opt 15:451-455.
4. Fincham EF, Walton I. 1957. The reciprocal actions of accommodation and convergence] Physiol (Land)137:488-508.
5. Bruce AS, Atchison DA, Bhoola H. 1995. Accommodation convergence relationships and age. Invest Ophthalmol Vis Sci36:406-413.
6. Kent PRo 1958. Convergence accommodation. Am l Optom Arch Am Acad Optom 35:393-406.
7. Mordi 1M. 1991. Accommodation, aging and presbyopia. Doctoral dissertation, State College of Optometry, State University of New York, New York, NY.
8. Mordi 1M, Ciuffreda KI. 1998. Static aspects of accommodation: Age and presbyopia. Vision Res38: 1643-1653.
9. Hofstetter HW. 1965. A longitudinal study of amplitude changes in presbyopia. Am J Optom Arch Am Acad Optom42:3-8.
10. Duane A. 1909. The accommodation and Donder's curve and the need of revising our ideas regarding them.lAMA52:1992-1996.
11. Ciuffreda KJ, Rosenfield MR, Mordi J, Chen HW. 2000. Accommodation, age, and presbyopia. In Franzen 0 (Ed), Accommodation and Vergence Interactions, pp 193-200. New York: Springer-Verlag.
12. Hung GK, Semmlow. 1980. Static behavior of accommodation and vergence: Computer simulation of an interactive dual-feedback system. IEEE Trans Biomed Engn27:439-447.
13. Hung GK. 1992. Adaptation model of accommodation and vergence. Ophthalmic Physiol Opt 12:319-326.
14. Hung GK, Ciuffreda KL Khosroyani M, liang Be. 2002. Models of accommodation. In Hung GK, Ciuffreda KI (Eds], Models ofthe Visual System, pp 287-339. New York: Kluwer Academic/Plenum Publishers
15. Saladin II. 1986. Convergence insufficiency, fixation disparity, and control systems analysis. Am] Optom Physiol Opt63:645-653.
16. Carlson NB, Kurtz D, Heath DA, Hines e. 1996. Clinical Procedures for Ocular Examination, 2nd ed. p 135.Stamford, Appleton&. Lange.
17. Ong E, Ciuffreda KI. 1995. Nearwork-induced transient myopia. Doc OphthalmoI91:57-85.
18. Objective accommodation measurements in prepresbyopic eyes using an auto refractor and an aberrometer Dorothy M. Win-Hall OD and Adrian Glasser PhD ,J Cataract Refract Surg. 2008 May
19. Accommodation measurements in a prepresbyopic and presbyopic population. Journal of Cataract and Refractive Surgery [01 Jul 2004,Ostrin LA , Glasser A.

Samir Sutar

Department of Optometry and Vision science, C L Gupta Eye Institute