The Role of Aberrometry in Accommodative Spasm After Myopic Photorefractive Keratectomy

PURPOSE: To report the role of aberrometry in a case of accommodative spasm following myopic photorefractive keratectomy (PRK). METHODS: Observational case report. RESULTS: One month following myopic PRK, a 33-year-old healthy woman complained of seeing multiple images and headache that interfered with her daily activities. Her corrected distance visual acuity (CDVA) was 20/40 in the right eye and 20/25 in the left eye with a manifest refraction of -0.75 -0.50 x 165 degrees in the right eye and plano -0.50 x 20 degrees in the left eye. Cycloplegic refraction was plano -0.50 x 165 degrees in the right eye and plano -0.5 x 20 degrees in the left eye. Ray tracing aberrometry showed variable refraction with increase in internal defocus, which after cycloplegia reduced from 1.019 to 0.142 mu m in the right eye and 0.366 to 0.230 mu m in the left eye. Total ocular aberrations decreased by 53.16% in the right eye (range: 1.511 to 0.708 mu m) and 18.77% (range: 0.671 to 0.545 mu m) in the left eye; corresponding simulated Snellen visual acuity charts also showed improvement. The patient was treated with one drop of cyclopentolate 1% three times a day for 6 weeks, following which headache and ghosting of images completely resolved. CONCLUSIONS: Accommodative spasm should be considered in patients with visual disturbances of uncertain causes following myopic refractive surgery. Ray tracing aberrometry can serve as a diagnostic and educative tool in managing such patients.