Phenotypes of autonomic regulation in children with habitual excessive accommodation strain: a cross-sectional study

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Abstract

BACKGROUND: Habitual excessive accommodation strain is one of the most common functional visual disorders in children and adolescents. This condition is also regarded as an important risk factor for myopia. Despite the high prevalence of habitual excessive accommodation strain, the influence of the autonomic nervous system on its clinical course, as well as the phenotypic patterns of autonomic regulation that determine disease behavior, remains insufficiently studied, which underscores the relevance of this investigation.

AIM: To perform a comprehensive assessment of autonomic nervous system status in children and adolescents with habitual excessive accommodation strain using integrated analysis of objective and subjective markers of autonomic regulation, in order to identify associations between autonomic regulation phenotypes and functional characteristics of the accommodative apparatus.

METHODS: A single-center, cross-sectional, comparative study was conducted. The study was conducted at the Department of Vision Preservation, City Clinical Polyclinic No. 29 between May and September 2025. A total of 150 children aged 6–17 years were enrolled; after applying exclusion criteria, two groups were formed: the main group, consisting of patients with habitual excessive accommodation strain (n = 102), and a control group (n = 48). All participants underwent ophthalmologic evaluation with assessment of refraction and accommodative function, cardiointervalography with heart rate variability analysis, dermographism testing, and questionnaire-based evaluation using the Composite Autonomic Symptom Score-31.

RESULTS: Compared with controls, patients with habitual excessive accommodation strain demonstrated significantly reduced amplitude of accommodation (8.6 ± 1.9 vs 11.2 ± 2.1 D; p < 0.001), relative accommodation reserve (1.4 ± 0.6 vs 2.6 ± 0.7 D; p < 0.001), and accommodative facility (5.3 ± 1.8 vs 9.1 ± 2.0 cycles/min; p < 0.001). Integrated analysis identified four phenotypes of autonomic regulation, among which the autonomic dissociation phenotype (38.2% of patients) was the most unfavorable. It was characterized by discordance between objective and subjective autonomic function markers, minimal accommodative parameters, and the greatest difference between manifest and cycloplegic refraction (1.3 ± 0.3 D).

CONCLUSION: The autonomic dissociation phenotype is a clinically significant marker of unfavorable course in habitual excessive accommodation strain in children. These findings highlight the importance of stratifying patients according to autonomic regulation phenotype to predict the severity of accommodative dysfunction and to guide development of personalized preventive strategies.

About the authors

Anzhella Zh. Fursova

Novosibirsk Regional Clinical Hospital; Novosibirsk State Medical University

Author for correspondence.
Email: anzhellafursova@yandex.ru
ORCID iD: 0000-0001-6311-5452
SPIN-code: 2015-0905

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Novosibirsk; Novosibirsk

Manizha K. Artykova

City Clinical Polyclinic No. 29, Novosibirsk

Email: manija_artikova@mail.ru
ORCID iD: 0009-0004-2828-4540
SPIN-code: 9666-8467

MD

Russian Federation, Novosibirsk

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