Evaluation of Ocular Accommodation, Convergence and Fusional Vergence Changes during Ramadan

Document Type : Research Paper


1 Department of Optometry, Faculty of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


Introduction: There are a few researches regarding the effects of Islamic fasting on visual system. The aim of this study was to investigate the effects of Ramadan fasting on the amplitude of accommodation (AA), near point of convergence (NPC), positive and negative fusional vergences (PFV and NFV, respectively) in visually healthy fasters.  Methods: AA, NPC, PFV and NFV at far (6m) and near (40cm) were measured in 30 male students. Nutritional habits in a week before each examination visit were assessed with the Food Frequency Questionnaire (FFQ). Results: Mean age and fasting average experience were 23.9 and 10 years, respectively. AA and NPC showed significant changes (p<0.05) during Ramadan; but there was no significant difference before and after Ramadan in these parameters. NFV blur, break and recovery points at far significantly reduced in Ramadan than before (p=0.003, p=0.005, p=0.003, respectively) with insignificant compensation after Ramadan. Results showed that there was no significant correlation between changes in diet pattern and AA, NPC and distant NFV variations (p<0.05).
Conclusion: Some visual problems may be reported at far and near visual tasks during Ramadan; but most of the problems may be resolved after it. Some visual preparations may be needed for more effective visual activities during Ramadan; essentially for students with intensive visual tasks. Vision therapy may be suggested along with nutrient pattern improvement during Ramadan.


1. Ziaee V, Razaei M, Ahmadinejad Z, Shaikh H, Yousefi R, Yarmohammadi L, et al. The changes of metabolic profile and weight during Ramadan fasting. Singapore Med J 2006; 47(5):409-414.
2. Finch GM, Day JE, Razak, Welch DA, Rogers PJ. Appetite changes under free-living conditions during Ramadan fasting. Appetite. 1998 Oct; 31(2):159-70.
3. Abdalla AH, Shaheen FA, Rassoul Z, Owda AK, Popovich WF, Mousa DH, et al. Effect of Ramadan Fasting on Moslem Kidney Transplant Recipients. Am J Nephrol 1998;18:101-104
4. Ural E, Kozdag G, Kilic T, Ural D, Sahin T, Celebi O, et al. The effect of Ramadan fasting on ambulatory blood pressure in hypertensive patients using combination drug therapy. J Hum Hypertens. 2008 Mar; 22(3):208-10.
5. Temizhan A, Tandogan I, Dönderici O, Demirbas B. The effects of Ramadan fasting on blood lipid levels. Am J Med. 2000 Sep; 109(4):341-2.
6. Iraki L, Bogdan A, Hakkou F, Amrani N, Abkari A, Touitou Y. Ramadan diet restrictions modify the circadian time structure in humans. A study on plasma gastrin, insulin, glucose, and calcium and on gastric pH. J Clin Endocrinol Metab. 1997 Apr; 82(4):1261-73.
7. Miratashi SAM, Shoja MR. [Effect of Ramadan fasting on physiologic myopia. The journal of Qazvin University of Medical Sciences & Health Services. 2000; 15: 26-33.] Persian
8. Ghasemi Boroumand M, Aghazadeh Amiri M, Amiri Z. [Relationship between fasting and myopic changes in the age group of 21-40 years. Pejouhandeh Res J. 2000; 17(5): 33-37.] Persian
9. Salehi A, Meamarzadeh SA, Akhlaghi MR, Rismanchian A, Jafari AG. Effect of Ramadan fasting on physiologic myopia. Journal of Shahrekord University of Medical Sciences 2008; 10(2):88-93.
10. Zandi AR. [Evaluation of myopic degree mean 1 month before and after Ramadan. J Res Med Sci. 2003; 3(8): 115] Persian
11. Rabbanikhah Z, Rafati N, Javadi MA; Sanago M. Effect of Religious Fasting on Intraocular Pressure in Healthy Individuals. Bina J Ophthalmol 2005; 10 (4): 489-492.
12. Kayakcioglu O, Guler C. Religious fasting and intraocular pressure. J Glaucoma 2000; 9:413-414.
13. Roky R, Houti I, Moussamih S, Qotbi S, Aadil N. Physiological and chronobiological changes during Ramadan intermittent fasting. Ann Nutr Metab 2004; 48:296-303.
14. K Masuda, T Ueda, Y Nawa, Y Hara, H Uozato. Asthenopia Originating From Lack of Sleep during Late Night Shift. Invest Ophthalmol Vis Sci 2005; 46: E-Abstract 5611. © 2005 ARVO.
15. Rabbanikhah Z,  Javadi MA, Karimian F,  Rouhani MR,  Zamani M,  Banaee T,  et al. [Effect of Religious Fasting on Basal Tear Secretion, Tear Break up Time and Intraocular Pressure. Bina J Ophthalmol 2007; 12 (4): 485-491.] persian
16. Tutt R, Bradley A, Begley C, Thibos LN. Optical and visual impact of tear break-up in human eyes. Invest Ophthalmol Vis Sci 2000; 41(13):4117-23.
17. Caloroso EE, Rouse MW, Cotter SA. Clinical management of strabismus. Butterworth-Heinemann Medical, 1993.
18. Scheiman M, Wick B. Clinical management of binocular vision; heterophoric, accommodative, and eye movement disorders. Baltimore: Lippincott Williams &Wilkins, 2002.
19. Duckman RH. Visual development, diagnosis, and treatment of the pediatric patient. Philadelphia: Lippincott Williams & Wilkins, 2006.
20. Borsting E, Rouse MW, Deland PN, Hovett S, Kimura D, Park M, et al. Association of symptoms and convergence and accommodative insufficiency in school-age children. Optometry. 2003 Jan; 74(1):25-34.
21. Grisham D, Powers MK, Riles P, Visual skills of poor readers in high school. Optometry. 2007 Oct; 78(10):542-9.
22. Kathleen Mahan, L. Escott-Stumps, S. Krause's Food & Nutrition Therapy, 12th ed, Saunders, 2008.
23. Rosenfield M, Cohen AS. Repeatability of clinical measurements of the amplitude of accommodation. Ophthalmic Physiol Opt 1996; 16:247-249.
24. Hoffstetter HW. Useful age-amplitude formula. Optometric World 1950; 38(11):42-45.
25. Hoffman LG, Rouse M. Referral recommendations for binocular function and/or developmental perceptual deficiencies. J Am Optom Assoc 1980; 51:119–26.
26. Shippman S, Infantino J, Cimbol D, Cohen KR, Weseley AC. Convergence insufficiency with normal parameters. J Pediatr Ophthalmol Strabismus 1983; 20:158 61.
27. Hayes GJ, Cohen BE, Rouse MW, De Land PN. Normative values for the nearpoint of convergence of elementary schoolchildren. Optom Vis Sci 1998;75:506–12.
28. Helveston EM, Weber JC, Miller K, Robertson K, Hohberger G, Estes R, et al. Visual function and academic performance. Am J Ophthalmol 1985; 99:346–55.
29. Pickwell D. Binocular Vision Anomalies: Investigation and Treatment. London: Butterworths, 1989.
30. London R. Near point of convergence. In: Eskridge JB, Amos JF, Bartlett JD, eds. Clinical Procedures in Optometry. Philadelphia: Lippincott, 1991.
31. Griffin JR, Grisham JD. Binocular Anomalies: Diagnosis and Vision Therapy, 3rd ed. Boston: Butterworth-Heinemann, 1995.
32. Waterhouse J, Alkib L, Edwards B, Reilly T. Diurnal changes in sleep, food and fluid intakes, and activity during Ramadan, 2006, in the UK: some preliminary observations. Biological Rhythm Research. Dec 2008; 39(6), 449-467.
33. Karaagaoglu N, Yucecan  S. Some behavioural changes observed among fasting subjects, their nutritional habits and energy expenditure in Ramadan. Int J Food Sci Nutr. 2000 Mar; 51(2):125-34.
34. Roky R, Iraki L, HajKhlifa R, Lakhdar Ghazal N, Hakkou F. Daytime Alertness, Mood, Psychomotor Performances, and Oral Temperature during Ramadan Intermittent Fasting. Ann Nutr Metab. 2000; 44(3):101-7.
35. Zerguini Y, Kirkendall D, Junge A, Dvorak J. Impact of Ramadan on physical performance in professional soccer players. Br J Sports Med. 2007 Jun; 41(6):398-400.
36. Meckel Y, Ismaeel A, Eliakim A. The effect of the Ramadan fast on physical performance and dietary habits in adolescent soccer players. Eur J Appl Physiol. 2008 Apr; 102(6):651-7.
37. Antona B, Barrio A, Barra F, Gonzalez E, Sanchez I. Repeatability and agreement in the measurement of horizontal fusional vergences. Ophthalmic Physiol Opt. 2008 Sep; 28(5):475-91.