# High-Order Aberrations: A Key Factor in Accommodative Dysfunctions
## 2 Materials and Methods  
### Subjects  
S Sixty-three healthy subjects were recruited for this study, excluding those with a history of ocular pathology, ocular surgery, orthokeratology or those taking medication that could affect vision, as certain conditions could affect HOAs. They first completed a questionnaire with the CISS (Convergence Insufficiency Symptoms Survey) questions to analyze whether they had symptoms associated with near-vision tasks and to determine whether they were considered symptomatic or asymptomatic according to the criteria of this survey. A score of 21 or more was considered symptomatic [12]. After completing the questionnaire, they underwent an ophthalmic examination, following the procedures reported by [PERSON] et al. [10], which included the assessment of the following:  
1. Objective refraction with static retinoscopy;
2. Subjective refraction was determined for each eye, initiating with the value obtained from objective refraction, and selecting the maximum positive lens power that provided the best visual acuity;
3. Horizontal phoria, measured using the von Graefe technique for both distance and near vision. A phoropter equipped with Risley prisms was used: 12 base-in and 6 base-out for distance vision, and 15 base-in and 9 base-out for near vision. For the distance measurement, a letter column with a visual acuity of 0.8 was used at 6 m, and for near vision, a letter column with the same visual acuity was used at 40 cm. 4. Positive and negative fusional vergences were assessed for both distance and near vision, with the same target used for phoria measurement. Blur, break, and recovery values were recorded. 5. The AA was used with the minus lens method, adding negative lenses in 0.25 D increments until the subject reported that the line of letters before their maximum visual acuity at 40 cm is blurred. 6. The lag of accommodation (LA) with MEM (monocular estimated method) retinoscopy was performed along the horizontal axis, and the plus or minus lens power was estimated to neutralize the movement of the reflex seen through the retinoscope, while the subject read the words of a MEM card. 7. The accommodation facility (AF) at near vision was measured during 1 min and using \(\pm\)2.00 D flippers, while the subject fixated on a target with letters one line below the subject's maximum visual acuity. 8. Positive and relative accommodation (PRA and NRA, respectively) was measured, with the subject fixating on a target with letters one line below the subject's maximum visual acuity placed at 40 cm, and adding negative (for PRA) or positive (for NRA) lenses until the subject reported blurred vision. The diagnosis of binocular and accommodative dysfunctions was made based on the results obtained in these examinations and according to previously reported criteria [10,13]. Subjects with binocular dysfunctions were not included in the study, and accommodative dysfunctions were classified according to the following criteria [10,13]:  
1. INFA: present monocular AF \(\leq\) 6 cpm and binocular \(\leq\) 3 cpm, PRA \(\leq\) 1.25 D and NRA \(\leq\) 1.50 D.
2. EA: present variable VA, variable static retinoscopy/subjective refraction, monocular AF \(\leq\) 6 cpm with difficulty with the lens +2.00 D, and binocular AF \(\leq\) 3 cpm with difficulty with the lens +2.00 D or MEM \(<\) +0.25 D or NRA \(\leq\) 1.50 D.
3.