Psychoemotional status and autonomic nervous system regulation in children with habitual excessive accommodation

Background. Habitual excessive accommodation (HEA) in children represents a multifactorial pathophysiological condition involving ophthalmic dysfunction alongside autonomic and neuroendocrine dysregulation. Identification of pathogenetic interrelations is essential for the development of integrated diagnostic and therapeutic approaches aimed at preventing progression of both visual and systemic disturbances. Purpose: To assess the psychoemotional status of children with habitual excessive accommodation and to examine its relationship with clinical manifestations of accommodative dysfunction. Materials and methods. Between May and July 2025, 150 children aged 6–17 years were examined at City Clinical Polyclinic № 29, including a main group with habitual excessive accommodation (n = 102) and a control group (n = 48), comparable in age and sex. Ophthalmic examination included assessment of uncorrected and best-corrected visual acuity; manifest and cycloplegic refraction; and accommodative amplitude, reserve, and facility. Psychoemotional status was evaluated using the eight-color Lüscher test with calculation of the autonomic coefficient (AC) and total deviation score (TDS). Serum cortisol concentration was measured in the morning under fasting conditions by enzyme-linked immunosorbent assay (ELISA). Results. Children with HEA showed a statistically significant reduction in accommodative amplitude (8.6 ± 1.9 D vs 11.2 ± 2.1 D in controls), accommodative reserve (1.4 ± 0.6 D vs 2.6 ± 0.7 D), and accommodative facility (5.3 ± 1.8 vs 9.1 ± 2.0 cycles/min). Accommodative parameters decreased with increasing HEA severity. Psychoemotional assessment revealed a higher median TDS (14 ranks vs 8 in controls) and elevated AC values (1.6 ± 0.8 vs 0.4 ± 0.7), reflecting sympathetic predominance. Autonomic dissociation (AC > +1.0 combined with altered color preference patterns) was identified in 38.2 % of children with HEA and was associated with lower accommodative parameters and higher TDS values (median 16 ranks). Serum cortisol levels exceeded those of the control group (432 ± 70 vs 368 ± 65 nmol/L), particularly in children with autonomic dissociation (456 ± 68 nmol/L). Cortisol levels correlated positively with TDS (ρ = 0.47) and negatively with accommodative amplitude (ρ = −0.41). Conclusion. The study demonstrated that habitual excessive accommodation in children is characterized by a combined ophthalmic, psychoemotional, and neuroendocrine imbalance. A high level of psychoemotional stress was recorded, associated with autonomic dissociation and a shift of autonomic balance toward sympathetic predominance; increased basal cortisol levels reflect systemic involvement of stress-realizing mechanisms. This indicates disintegration of autonomic nervous system regulators and supports the need for a comprehensive approach to correction.

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