Diurnal Variation in Accommodation, Binocular Vergence, and Pupil Size

Abstract

SIGNIFICANCE Our results show significant diurnal variations in accommodative function and the magnitude of the phoria. Therefore, when comparing visual measures in clinical or laboratory settings, performing the visual examination at the same time of day (±1 hour) is encouraged. PURPOSE The aim of this study was to evaluate the accommodation, binocular vergence, and pupil behavior on three different times during the day. METHODS Twenty collegiate students (22.8 ± 2.1 years) participated in this study. Participants visited the laboratory on three different days at 2-hourly intervals (morning, 9:00 to 11:00 am; afternoon, 2:00 to 4:00 pm; evening, 7:00 to 9:00 pm). The binocular vergence and accommodative function were measured using clinical optometric procedures, and the accommodative response and pupil function were evaluated in binocular conditions using the WAM-5500 autorefractometer. RESULTS The accommodative amplitude for the right and left eyes showed statistically significant differences for the time interval (P = .001 and P = .02, respectively), revealing higher accommodative amplitude in the morning and afternoon in comparison with the evening. Participants were more esophoric when assessed in the morning in comparison with the evening at far and near (P = .02 and P = .01, respectively) and when assessed in the afternoon in comparison with the evening at far distance (P = .02). The magnitude of accommodative response was higher in the morning, and it decreased throughout the day at 500 (P < .001), 40 (P = .05), and 20 cm (P < .001). No statistically significant differences were obtained for any other variable. CONCLUSIONS This study shows small diurnal variations in some accommodative and binocular vergence parameters, but no effects were observed for the pupil response. These outcomes are of special relevance for eye care specialists when performing repeated accommodative or binocular vergence measures. However, the diurnal variations were modest and may not influence a routine orthoptic examination.