Walsh & Hoyt: History

The symptoms of patients with disturbances of accommodation tend to be nonspecific but some aspects of the history may be important. Patients with accommodative insufficiency, for instance, usually complain of blurred vision at near but not in the distance. Patients with the most common problem with accommodationpresbyopiamay report that the farther away they hold an object, the better they can see it. Some patients with accommodative insufficiency report monocular diplopia; others complain of discomfort during attempted reading, a noticeable delay in focusing when changing fixation from a distant to a near or a near to a distant object, or a combination of these symptoms. Some patients report headache, light intolerance, and other asthenopic symptoms. Frequently, presbyopia and other accommodative insufficient states can be precipitated with medications having anticholinergic effects.