Accommodation, refraction and cycloplegia: a review

Resumen

Accommodation is a type of reflex mediated by many cells and is thus called synkinesis. It is involuntary and produced by the fact that the retina is able to detect the plane of the image by computing the contrast sensitivity of the different wavelengths of the cones for red and blue. Since this involuntary synkinesia is associated with the triad accommodation + convergence + myosis, it is always present when refracting subjectively (or when performing retinoscopy or automatic autorrefractometry), and must be taken into account by performing cycloplegia after all the subjective tests of spectacles and phoria have been tried, both monocularly and binocularly, before prescribing glasses, drops or surgery, according to the best medical criteria to benefit the patient. In this paper we review current concepts on the subject and point out their importance in the context of medical care of visual health, both in school children and in adults, whether myopic or hyperopic. All these aspects show us that refractive problems are now currently considered conditions for medical treatment.