Accommodative Function May Be Affected By Type 1 Diabetes

Type 1 diabetes may alter accommodative functioning.

Accommodative function, particularly accommodative insufficiency, may be worsened by type 1 diabetes (T1D), according to a study published in Ophthalmic and Physiological Optics. T1D may also affect other accommodative parameters, which include accommodative amplitude, accommodative facility, and negative relative accommodation, according to the report.

Researchers included individuals with T1D (n=30; mean age, 22.90 years; 60% men) and control group participants (n=30; mean age, 23.67 years; 63% men) without presbyopia or retinopathy in the comparative, cross-sectional investigation. All participants underwent nonmydriatic fundus photography, visual acuity (VA) assessment, and an accommodative function examination, which included measurements of amplitude of accommodation (AA), accommodative response, accommodative facility, and negative and positive relative accommodation. Refraction, intraocular pressure (IOP) and VA was similar between the 2 cohorts.

The accommodative function assessment revealed lower AA (P <.001) and accommodative facility (P <.005) and higher negative relative accommodation (P =.03) among individuals with T1D compared with control group participants, according to the report.

Normal amplitude of accommodation (63% vs 97%; P =.001 and 70% vs 97%; P =.006 for the OD and OS, respectively), accommodative facility (53% vs 90%; P =.002 and 53% vs 87%; P =.005 for the OD and OS, respectively), and negative relative accommodation (57% vs 87%; P =.03) values were less common among participants with T1D compared with control group participants.

[F]rom a clinical point of view, the results verify the association of T1D with accommodative insufficiency.

Patients with T1D who did not have normal accommodative function were more frequently categorized as having insufficiency rather than excess. Overall, 20% of patients with T1D had accommodative insufficiency and 27% had accommodative infacility compared with 0% (P =.02) and 3.3% (P =.03) of control group participants, respectively.

The team noted significant correlations between amplitude of accommodation and age (r, -0.687; P <.001) and duration of diabetes (r, -0.571; P =.001). Duration of diabetes was also correlated with monocular (r, -0.322; P =.01) and binocular (r, -0.375; P =.003) accommodative function and negative relative accommodation (r, 0.327; P =.01).

“[T]he results of this work and others both demonstrate decreased accommodation in subjects with T1D causing an increase in accommodative disorders,” according to the study authors. “The main contribution of this study is to note that AA is not the only parameter affected, as both [accommodative facility] and [negative relative accommodation] were also altered significantly. Furthermore, from a clinical point of view, the results verify the association of T1D with accommodative insufficiency.”

Study limitations include a small sample size and an inability to blind examiners to participants’ T1D status.


Silva-Viguera M-C, Bautista-Llamas M-J. Accommodative disorders in non-presbyopic subjects with type 1 diabetes without retinopathy: a comparative, cross-sectional study. Ophthalmic Physiol Opt. Published online May 17, 2023. doi:10.1111/opo.13164