The relative infrequency of the occurrence of subnormal accommodation is perhaps the reason it is so easily overlooked. It has been said that the difference between the consultant and the average practitioner in a given field is that the consultant has the ability to recognize and treat correctly the 25 per cent of conditions which the average practitioner does not recognize or treat. Functional insufficiency or subnormal accommodation falls into this small group of difficult cases observed by the ophthalmologist. It is suggested that deficiency of accommodation in young persons would be more often recognized if the profession would adhere more religiously to the taking of the accommodative near point and its interpretation. Refraction is fundamentally an accommodative problem.
Jackson1 stressed the value of taking the near point of accommodation as a routine, and pointed out that it is often neglected :
Asthenopia from eye strain usually depends