Accommodative functions in opium users and non-users
Medical hypothesis, discovery & innovation in optometry,
Vol. 5 No. 3 (2024),
25 January 2025
,
Page 103-111
https://doi.org/10.51329/mehdioptometry204
Abstract
Background: Emerging evidence highlights a concerning prevalence of accommodative and convergence anomalies in individuals with opioid use disorder. However, there remains a significant scarcity of data comparing accommodative functions of opium users and non-users. Hence, we investigated potential changes in accommodative functions of opium users compared to that of non-users. Furthermore, we evaluated changes in these parameters after administering 5% phenylephrine eye drops, both within and between the two groups.Methods: This cross-sectional case-control study recruited opium users and non-users. The binocular amplitude of accommodation (AA), monocular estimate method (MEM), negative and positive relative accommodation (NRA and PRA, respectively), and monocular and binocular accommodative facility (AF) were assessed and documented. All measurements were repeated 30 min after instillation of one drop of 5% phenylephrine hydrochloride eye drops.
Results: We recruited 103 opium users and 107 non-users, with comparable mean ages (P > 0.05) but significantly different sex ratios (P < 0.05), with men outnumbering women among the opium users. All accommodative functions measured before and after the instillation of 5% phenylephrine, along with the differences in their values between the two time points, were comparable between the two groups (all P > 0.05), with the exception of the right-eye AF, which was significantly higher in non-users than in opium users after instillation (P < 0.05). Within the opium user group, all accommodative functions exhibited significant differences between pre- and post-instillation measurements (all P < 0.05), except for NRA, which did not change (P > 0.05). In contrast, the non-user group showed no significant differences between pre- and post-instillation measurements for all accommodative functions (all P > 0.05), except in the AA and the right-eye MEM (both P < 0.05).
Conclusions: We observed small but significant changes in most baseline accommodative functions after the application of 5% phenylephrine eye drops in opium users. In contrast, most parameters remained unchanged in healthy non-users. When comparing the results between the two groups pre- and post-application of phenylephrine, we found similar accommodative functions overall. However, non-users had a significantly higher value for the right-eye AF following the instillation. To better understand potential binocular anomalies in opium users, further longitudinal studies that are matched for age and sex should be conducted, focusing on additional aspects of binocular vision and ocular motility.
Keywords:
- opium use
- opium addiction
- phenylephrine hydrochloride
- binocular vision
- ocular accommodation

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13. Scheetz J, Koklanis K, Long M, Morris ME. Accuracy and Efficiency of Orthoptists in Comprehensive Pediatric Eye Examinations. Am Orthopt J. 2016 Jan;66(1):98-106. doi: 10.3368/aoj.66.1.98. PMID: 27799583.
14. Hamou S, Ghiaee S, Chung C, Lloyd M, Khem K, Chi Zhang X. Emergency Department Slit Lamp Interdisciplinary Training Via Longitudinal Assessment in Medical Practice. West J Emerg Med. 2024 Sep;25(5):725-734. doi: 10.5811/westjem.18514. PMID: 39319803; PMCID: PMC11418879.
15. Collis S, Yung M, Parikh N. Evaluation of an Instructional Video and Simulation Model for Teaching Slit Lamp Examination to Medical Students. J Acad Ophthalmol (2017). 2023 Sep 26;15(2):e215-e222. doi: 10.1055/s-0043-1775577. PMID: 37766880; PMCID: PMC10522417.
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17. Hashemi H, Pakbin M, Ali B, Yekta A, Ostadimoghaddam H, Asharlous A, Aghamirsalim M, Khabazkhoob M. Near Points of Convergence and Accommodation in a Population of University Students in Iran. J Ophthalmic Vis Res. 2019 Jul 18;14(3):306-314. doi: 10.18502/jovr.v14i3.4787. PMID: 31660110; PMCID: PMC6815340.
18. Manion GN, Stokkermans TJ. The Effect of Pupil Size on Visual Resolution. 2024 Feb 28. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 38753941.
19. Momeni-Moghaddam H, McAlinden C, Azimi A, Sobhani M, Skiadaresi E. Comparing accommodative function between the dominant and non-dominant eye. Graefes Arch Clin Exp Ophthalmol. 2014 Mar;252(3):509-14. doi: 10.1007/s00417-013-2480-7. Epub 2013 Oct 26. PMID: 24158371.
20. Yekta A, Hashemi H, Khabazkhoob M, Ostadimoghaddam H, Ghasemi-Moghaddam S, Jafarzadehpur E, Shokrollahzadeh F. The distribution of negative and positive relative accommodation and their relationship with binocular and refractive indices in a young population. J Curr Ophthalmol. 2017 Jan 21;29(3):204-209. doi: 10.1016/j.joco.2017.01.001. PMID: 28913512; PMCID: PMC5587222.
21. Abraham LM, Kuriakose T, Sivanandam V, Venkatesan N, Thomas R, Muliyil J. Amplitude of accommodation and its relation to refractive errors. Indian J Ophthalmol. 2005 Jun;53(2):105-8. doi: 10.4103/0301-4738.16173. PMID: 15976465.
22. Redondo B, Serramito M, Vera J, Alguacil-Espejo M, Rubio-Martínez M, Molina R, Jiménez R. Diurnal Variation in Accommodation, Binocular Vergence, and Pupil Size. Optom Vis Sci. 2023 Dec 1;100(12):847-854. doi: 10.1097/OPX.0000000000002091. Epub 2023 Nov 27. PMID: 38019970.
23. Park SM, Moon BY, Kim SY, Yu DS. Diurnal variations of amplitude of accommodation in different age groups. PLoS One. 2019 Nov 26;14(11):e0225754. doi: 10.1371/journal.pone.0225754. PMID: 31770414; PMCID: PMC6879161.
24. Sarkar S, Hasnat AM, Bharadwaj SR. Revisiting the impact of phenylephrine hydrochloride on static and dynamic accommodation. Indian J Ophthalmol. 2012 Nov-Dec;60(6):503-9. doi: 10.4103/0301-4738.103773. PMID: 23202387; PMCID: PMC3545125.
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