Near Point Of Accommodation Research Articles

The Impact of Optimized Blinking on Vision and Related Parameters in Individuals With Computer Vision Syndrome: A Single-Blind Randomized Controlled Trial.

Computer vision syndrome (CVS) has become a significant issue for individuals working on computers and digital devices for extended periods. The ocular and periocular symptoms and signs associated with CVS are a major concern, affecting individuals physically and financially. Additionally, CVS has been linked to the rapid progression of myopia, exacerbating the situation. Blinking has been one of the major treatment methods for the treatment of CVS. This study presents a unique and novel randomized controlled therapeutic trial that evaluates the impact of extended blinking therapyon eyehealth and vision, along with other related parameters. Materialsandmethods: The present studyis a randomized controlled trial conducted from September 2022 to April 2024. Participants aged 18-40 with CVSand a computer vision syndrome questionnaire (CVS-Q)score of ≥6, with mild to moderate refractive error (between -6D and +4D), were included. The sample size was determined based on a pilot study, resulting in a minimum required sample size of 36 patients (18 cases and 18 controls). Participants were randomly assigned to either the case (interventional) or control (conventional) group and were followed up for six months. Cases received conventional CVS treatment plus optimized blinking exercises, while controls received conventional therapy only. Comprehensive ocular assessments were conducted bi-monthly over six months, evaluating changes in uncorrected visual acuity (UCVA), refractive error, near point of accommodation (NPA), near point of convergence (NPC), Schirmer's test, and tear film breakup time (TBUT). The study included 20 patients in the case group and 18 in the control group, primarily aged 20-29 (60.5%). Most patients used laptops for their activities (55.26%). The CVS-Q score significantly decreased in both groups following treatment, with both cases and controls showing significant improvement (p<0.001 for both groups). UCVA in the right eye (RE) and left eye (LE) of the cases improved significantly post-treatment in the interventional group (RE: p=0.002; LE: p<0.001). A significant change in refractive error, which is measured as spherical equivalent (SE), was seen among cases following treatment (RE: p<0.001; LE: p=0.021). Controls showed no significant changes in visual acuity or refractive error. The NPAin the cases improved significantly in the RE (p=0.027) but not in the left. The NPC in the intervention group showed no significant change, while controls showed considerable improvement (p=0.042). Schirmer's test results showed no significant change in either group. However, TBUTin the cases improved significantly (RE: p<0.001; LE: p<0.001). In the controls, TBUT decreased significantly, indicating a deterioration in tear film stability. Asthenopia grades improved considerably in cases, while controls showed only some improvement. Severe symptoms still remained in the control group, emphasizing the potential benefits of the blinking exercise in reducing asthenopia symptoms. Optimized blinking therapy significantly improves vision and refractive error, tear film stability, and discomfort, making it beneficial for chronic computer users to maintain ocular health and enhance productivity and quality of life.

Association of smartphones use, ocular symptoms and binocular dysfunctions in adolescents: a hospital-based cross-sectional study

ABSTRACT Purpose Given the current scenario of increased smartphone use in youth, this study aims to evaluate the proportion of ocular symptoms and binocular dysfunction and their association with smartphone use in adolescents through a hospital-based cross-sectional study. Methods The participants were asked to fill out questionnaires related to smartphone use and symptoms of eyestrain experienced (Balik et al. and Kucer). They were asked about the following seven symptoms: blurring of vision, redness, visual disturbance, secretion, inflammation, lacrimation, and dryness. Each symptom out of the 7, was scored on a scale of 0–1 and was used to calculate an Ocular Symptom Score (OSS) by summing the scores of each symptom.Depending upon the duration of smartphone usage, the participants were classified into four groups: <2 hours/day, 2–4 hours/day, 4–6 hours/day, and >6 hours/day. Binocular functions were assessed using near point of convergence (NPC), near point of accommodation (NPA), Accommodative convergence/Accommodation (AC/A) ratio, dissociated heterophoria, and binocular accommodative facility (BAF). Results A total of 123 smartphone user adolescents, aged 10–19 years were included in this study. The mean age of the study population was 16.58 + 2.8 years, out of which 52.03% were males. Prevalence of ocular symptoms was higher in groups with greater duration of smartphone use (2 to 4, 4 to 6, and >6 hours/day as compared to <2 hours/day: 90.48%, 94.74%, 100% vs. 75% respectively). The mean of NPC was 8.51, it was highest in subjects using smartphones for >6 hours. (p-value = .001). The mean AC/A ratio was 2.83 + 1.03: 1. A low AC/A ratio was associated with a longer duration of smartphone usage (p-value = .0001). The mean of BAF was 7.4 + 3.18 cycles/min, only 30 (24.4%) participants had BAF beyond the normal range (<5 cycles/min). The mean of BAF was lowest in the group with >6 hours/day of smartphone use (p-value < .0001). No significant change was found in NPA and dissociated heterophoria with the duration of smartphone usage. Conclusion Higher duration of smartphone use (>2 hours/day) is associated with various ocular symptoms and binocular dysfunction. However, additional research is necessary to authenticate the results of the study.

Pilot Study Assessing the Safety and Acceptance of a Novel Virtual Reality System to Improve Visual Function

ABSTRACT Purpose To assess the feasibility of the clinical use of a novel Virtual Reality (VR) training software designed to be used for active vision therapy in amblyopic patients by determining its preliminary safety and acceptance on the visual function of healthy adults. Methods Pilot study enrolling 10 individuals (3 men, 7 women, mean age: 31.8 ± 6.5 years) with a best-corrected visual acuity (BCVA) of ≥ .90 (decimal) in both eyes were evaluated before and after 20 minutes of exposure to the NEIVATECH VR system using the HTC Vive Pro Eye head mounted display. Visual function assessment included near (40 cm) and distance (6 m) cover test (CT), stereopsis, binocular accommodative facility (BAF), near point of convergence (NPC), near point of accommodation (NPA), accommodative-convergence over accommodation (AC/A) ratio and positive and negative fusional vergences. Safety was assessed using the VR Sickness Questionnaire (VRSQ) and acceptance using the Technology Acceptance Model ;(TAM). Changes in all these variables after VR exposure were analyzed. Results Short-term exposure to the NEIVATECH VR system only induced statistically significant changes in distance phoria (p = .016), but these changes were not clinically relevant. No significant changes were observed in VRSQ oculo-motricity and disorientation scores after exposure (p = .197 and .317, respectively). TAM scores showed a good acceptance of the system in terms of perceived enjoyment and perceived ease of use, although some concerns were raised in relation to the intention-to-use domain. Conclusion Exposure to the NEIVATECH VR system does not seem to adversely affect the visual function in healthy adults and its safety and acceptance profile seems to be adequate for supporting its potential use in other populations, such as amblyopic patients.

Comparison of Near Point of Accommodation and Near Point of Convergence with Positive Fusional Vergence among Young Adults, Bengaluru

Background: When encountered with mass screening and increased walk-in patients in outpatient departments (OPD), evaluating complete binocular vision assessment becomes time-consuming. Consequently, there is a need to streamline the testing process. This study also aims to explore if there are any correlations between Near Point of Accommodation (NPA) and Near Point of Convergence (NPC) with Positive Fusional Vergence (PFV). Methodology: A retrospective study was carried out at Sankara Eye Hospital in Bangalore. Data from patients aged 18 to 35, who underwent binocular vision assessment between 2016 and 2020, were included. Out of 101,896 patients who visited the hospital during this period, 3,449 attended the vision therapy clinic. Among them, 1708 patients met the criteria for inclusion, while 1,741 were excluded. Results: Out of 1708 subjects, 759 are females and 949 are males. The relationship between Near Point of Accommodation (NPA), Near Point of Convergence (NPC), and Positive Fusional Vergence (PFV) blur and break values were analysed. A positive correlation was observed between NPA and PFV blur (Spearman's rho = 0.069, p=0.004) and a negative correlation between NPC and PFV break (Spearman's rho = -0.370, p&lt;0.001). There was a significant difference between NPA and PFV blur, as well as NPC and PFV break (p=0.000), emphasizing the importance of incorporating all three tests in a binocular vision assessment. Conclusion: These results emphasize the necessity for complete binocular vision assessment to effectively diagnose and manage binocular vision anomalies. By accounting for the various parameters involved in this investigation, clinicians can enhance the precision and quality of their assessments and plan for appropriate treatment strategies for patients with binocular vision anomalies.

Utility of Structured Oculomotor, Balance, and Exercise Testing in Civilian Adults With Mild Traumatic Brain Injury.

Assessments of oculomotor, balance, and exercise function detect different responses to mild traumatic brain injury in sports-related mild traumatic brain injury. These assessments are understudied in the adult community mild traumatic brain injury population. We evaluated level 1 trauma center patients with nonsports-related mild traumatic brain injury on oculomotor functioning (near point of convergence and accommodation), balance (Balance Error Scoring System), and exercise tolerance (Buffalo Concussion Treadmill Test). A prospective, cohort study of adults with mild traumatic brain injury ( n = 36) were assessed at 1 wk and 1-mo post-mild traumatic brain injury ( n = 26) using near point of convergence, near point of accommodation, Balance Error Scoring System, Buffalo Concussion Treadmill Test, and the Rivermead Post Concussion Symptoms Questionnaire. Prevalence of test impairment and association between performance and mild traumatic brain injury-related symptom burden (Rivermead Post Concussion Symptoms Questionnaire scores) were characterized. Participants demonstrated varying levels of impairment (e.g., 33.3% oculomotor, 44.1% balance, and 55.6% exercise impairment at 1 wk). Participants displayed diverse impairment profiles across assessments. We observed medium-to-large correlations between poorer near point of convergence and Buffalo Concussion Treadmill Test performance and greater mild traumatic brain injury symptom burden. Clinical examinations of oculomotor function, balance, and exercise adopted from sports-related concussion assessments detect impairment in adult community members with mild traumatic brain injury. While findings warrant larger-scale replication, they imply that incorporating these simple, structured examinations into the assessment of mild traumatic brain injury may facilitate more personalized management strategies.

The distribution of near point of convergence, near point of accommodation and their association with interpupillary distance in young adults- A cross sectional study

Vergence dysfunctions and accommodation anomalies are the main causes of asthenopic symptoms. These may be related to differences in the anthropometric measurements.The anthropometric measurements have a significance in understanding human physical and physiological variations. This study was carried out with the purpose of measuring the near point of convergence (NPC), near point of accommodation (NPA) and to determine their association with interpupillary distance (IPD) in a population of North-western India.This was a cross sectional study carried out on young adults of 18-22 years age group. The NPC and NPA were measured with a Royal Air Force (RAF) scale. Distance IPD was measured with a ruler and autorefractometer. The results were analysed statistically to study the relation of the variables with each other.The average IPD of the study population was 62.18 mm, IICD was 29.65, NPC was 6.55 cm, NPA was 9.42 cm. The correlation between IPD and IICD was 0.15 (weak). The correlation between IPD and NPC was found to be 0.18, correlation between IPD and NPA OD was 0.35 and the correlation between IPD and NPA OS was 0.30, which all were statistically weak.The anthropometric measurements of the study population were similar to those reported by other studies on the Indian population. The correlation between NPA and IPD and that between NPC and IPD was found to be weak.

Change in three-dimensional choroidal vessel network after AR device assisted 1-hour visual task in 2D/3D mode in young healthy subjects.

The purpose of the study was to investigate the changes of choroidal blood perfusion in different layers and quadrants and its possible related factors after 1 h visual task by augmented reality (AR) device in two-dimensional (2D) and three-dimensional (3D) mode, respectively. Thirty healthy subjects aged 22-37 years watched the same video source in 2D and 3D mode separately using AR glasses for 1 h with a one-week interval. Swept-source optical coherence tomography angiography (SS-OCTA) was performed before and immediately after watching to acquire choroidal thickness (ChT), three-dimensional choroidal vascularity index (CVI) of large- and middle-sized choroidal vessels and choriocapillaris flow voids (FV%) at macular and peripapillary area. Near point of accommodation (NPA) and accommodative facility (AF) were examined to evaluate the accommodative ability. Pupil diameters by infrared-automated pupillometer under scotopic, mesopic and photopic condition were also obtained. Compared with pre-visual task, the subfoveal CVI decreased from 0.406 ± 0.097 to 0.360 ± 0.102 after 2D watching (p < 0.001) and to 0.368 ± 0.102 after 3D watching (p = 0.002). Pupil sizes under different illuminance conditions became smaller after both 2D and 3D watching (all p < 0.001). AF increased after both 2D and 3D watching (both p < 0.05). NPA receded in post-3D watching (p = 0.017) while a not significant tendency was observed in post-2D. A reduction in subfoveal choroidal blood flow accompanied with pupil constriction was observed immediately after 1 h visual task using AR glasses in 2D and 3D mode. Accommodative facility improved after 2D and 3D watching with AR glasses, whereas decrease in the maximum accommodation power was only found in 3D mode.

Nexus of ocular motility and dry eye.

To evaluate the effectiveness of vision therapy (VT) in patients with chronic presumed refractory dry eye disease (DED) and concurrent nonstrabismic binocular vision anomalies (NSBVAs). To propose an algorithmic approach to manage patients with refractory DED. Thirty-two patients with chronic (>1 year) presumed refractory DED and NSBVA were prospectively evaluated. The baseline dry eye evaluation and comprehensive orthoptic evaluation were done. VT was administered by a trained orthoptist for 2 weeks. The binocular vision (BV) parameters and percentage subjective improvement were assessed after the VT. On evaluation, 12 patients (37.5%) had both DED and NSBVA, and 20 patients (62.5%) had only NSBVA. Twenty-nine patients (90.62%) showed significant improvement in BV parameters following VT. Binocular near point of accommodation (median, range) improved from 17 (8-40) to 12 (5-26) mm (P value < 0.0001), and near point of convergence (median, range) improved from 6 (3-33) to 6 (5-14) (P value 0.004) with VT. Thirty-one patients (96.87%) reported symptomatic improvement after VT, and 62.5% of these showed more than 50% improvement in symptoms. The present study confirms the beneficial role of VT in the treatment of patients with DED with concurrent NSBVA. It is essential to diagnose and treat NSBVA in patients with DED to ensure complete relief of symptoms and patient satisfaction. As there is a significant overlap between symptoms of dry eye disease and that of NSBVA, a complete orthoptic evaluation is recommended in all patients presenting with refractory dry eye disease related symptoms.

A Study on the Impact of Post-Cataract Surgery Induced Astigmatism on the Near Point of Accommodation

A Study on the Impact of Post-Cataract Surgery Induced Astigmatism on the Near Point of Accommodation

New technology using crystalline lens autofluorescence for presbyopia and cataract grading.

To investigate whether fundus autofluorescence (FAF) obtained using an ultra-wide field (UWF) fundus camera with an artificial opacity pattern can grade the degree of presbyopia and nuclear cataract. Sixty eyes of 30 patients were enrolled in this prospective diagnostic study. The nuclear cataract (nuclear color/opalescence (NC/NO)) was graded according to the Lens Opacity Classification System III. The monocular near point of accommodation (NPA) was measured in eyes with NC3/NO3 or less. The mean gray value difference between the central 8 artificial opacity lesions and peripheral 8 artificial opacity lesions in the retinal AF was measured. The correlation between the mean gray value difference, NPA, and nuclear cataract grade was analyzed. The mean nuclear cataract grade of 60 eyes was 3.2 ± 1.6 and mean NPA of 37 eyes was 45.3 ± 16.1 cm. The mean gray value differences increased with increasing nuclear cataract grade (eyes with NC/NO grade 1, 53.3 ± 11.4; 2, 78.3 ± 13.6; 3, 95.2 ± 12.2; 4, 101.6 ± 11.9; 5, 109.0 ± 22.9; and 6, 121.1 ± 12.0; p < 0.001). The mean gray value difference was positively correlated with both the monocular NPA (R2 = 0.637; β coefficient = 1.009; 95% CI, 0.748 to 1.271; p < 0.001) and nuclear cataract grade (R2 = 0.661; β coefficient = 12.437; 95% CI, 10.097 to 14.778; p < 0.001). The FAF camera with an artificial opacity pattern attached can be used to effectively diagnose the degree of presbyopia and nuclear cataract.

The impact of smartphone use on accommodative functions: pilot study

ABSTRACT Evidence about the effect of smartphone use on accommodation is limited and inconclusive. Several studies have investigated either symptoms or near triad measures following smartphone use. These suggest that, certainly for the short term, smartphones have a negative impact on the near triad and produce symptoms. In addition, there is a body of recent work reporting cases of acute acquired concomitant esotropia (AACE) that may be caused by the accommodation-vergence demand of excessive smartphone use. A pilot study was undertaken to investigate accommodative measures before and after 30 minutes of smartphone use. Participants aged 16-40 years were invited to participate. Accommodative facility (AF), near point of accommodation (NPA), and near point of convergence (NPC) before and after 30 minutes of habitual smartphone use were assessed. NPA and AF were assessed with both eyes open (BEO), right eye (RE) and left eye (LE). Accommodative facility was assessed using ±2DS flipper lenses and measured in cycles per minute (cpm). NPA and NPC were assessed using the RAF rule and measured in centimeters. Data were analyzed in StatsDirect using non-parametric statistical tests. Eighteen participants were recruited, with a mean age of 24 years (SD: 7.6yrs). AF improved by 3cpm (p= .015) for BEO, 2.25cpm for RE (p = .004) and 1.5 cpm for the LE (p =. 278) after smartphone use. NPA with BEO became worse by 2 cm (p =.0474), with the RE worse by 0.5cms (p = .0474) and the LE, worse by 0.125 cms (p = .047). Convergence worsened by 0.75 cms (p = .018). Although these appeared to represent a change in measures following smartphone use, post-hoc analysis with Bonferroni correction demonstrated that these were not statistically significant at the 0.07 significance level. This pilot study found that there was no difference in accommodative and convergence measures before and after 30 minutes of smartphone use. These results suggest evidence contrary to the existing literature. There are several limitations to this pilot study and previous work, which are discussed. Suggestions on future work to explore the effect of smartphone use on the near triad to address limitations and further knowledge, in this area, are provided.

Refractive and Binocular Vision Status and Associated Asthenopia among Clinical Microscopists

Background Clinical microscopists are at a greater risk of developing binocular vision anomalies and asthenopia.&#x0D; Objective To assess the refractive and binocular vision status and to explore the association between the presence of asthenopic symptoms and microscopy work among clinical microscopists working at medical laboratory department.&#x0D; Method This cross-sectional study involved 37 clinical microscopists working at medical laboratory department of Dhulikhel Hospital, Nepal. The study was conducted from January to December 2013. Only those participants who had been using microscope for at least a year were enrolled in this study. Each participant underwent distance visual acuity (VA) assessment, refractions, and orthoptic evaluation, including measurement of distance and near phoria, near point of convergence (NPC), near point of accommodation (NPA), positive fusional vergence (PFV), adduction, and calculation of accommodation convergence/accommodation (AC/A) ratio. The tear test was also carried out in each subject. Information about use of glasses, microscopy work (duration, and time spent per day in microscope), and visual symptoms associated with the use of microscope such as eye strain, headache, double vision, and near vision were collected.&#x0D; Result The mean age of the clinical microscopists was 29 ± 5.7 years. The prevalence of refractive error was 56.76% and the mean spherical equivalent (SE) refractive error was -0.77 ± 0.86 D. Refractive error had neither correlation with microscopy work and asthenopic symptoms associated with it, and nor with binocular vision parameters- NPC, AA and AC/A ratio. However, there was a positive association between asthenopic symptoms and microscopy work. There was statistically significant difference between symptomatic and asymptomatic subjects for binocular vision parameters, including NPC, AA and positive fusional vergence (PFV) for near.&#x0D; Conclusion Microscopy work has an impact on near binocular vision. Asthenopic symptoms bear a positive association with microscopy work. Refractive error has no significant correlation with either microscopy works or associated asthenopic symptoms.

Binocular vision parameters in handloom silk weavers

Background: Focusing the gaze for prolonged periods on a fixed distance demands high visual efficiency in handloom silk weavers and might result in various accommodative and vergence dysfunctions. The aim of the present study was to assess accommodative and vergence parameters and determine the frequency of non-strabismic binocular vision anomalies (NSBVAs) among handloom silk weavers.&#x0D; Methods: In this cross-sectional study, we recruited voluntary handloom silk weavers from the Government-aided Society of Arignar Anna Silk Co-op Society K.H.-1, Kanchipuram, aged 20–39 years. All participants underwent preliminary visual examinations and comprehensive binocular vision testing of accommodative and vergence parameters. Sensory evaluation was performed using stereopsis testing and the Worth 4 Dot test. Motor evaluation included the ocular motility assessment, heterophoria checks for distance and near, near point of convergence, negative and positive fusional vergences for distance and near, vergence facility, negative and positive relative accommodations, both monocular and binocular near points of accommodation, and accommodative facility. The monocular estimate method was used to determine the accommodative response. Quantitative data are expressed as mean (standard deviation [SD]), and qualitative data are expressed as frequency (percentage).&#x0D; Results: We recruited a total of 72 weavers, including 41 (56.9%) men and, 31 (43.1%) women with mean (SD) age, working hours, and work experience of 34.15 (4.12) years, 9 (2.5) h/day, and 17.5 (6.9) years, respectively. Of the 29 (40.3%) weavers with a refractive error, 18 (25%) had astigmatism; seven (9.7%) had myopia; and four (5.6%) had hyperopia. Of the 72 weavers, 38 (52.8%) presented with NSBVAs, including 13 (18.1%) with accommodative dysfunctions, 11 (15.3%) with vergence dysfunctions, and 14 (19.4%) with combined accommodative and vergence dysfunctions. Accommodative insufficiency was the most prevalent dysfunction among all NSBVAs. Overall, 57 (79.2%) patients reported vision-related symptoms during their weaving hours, all with NSBVAs (n = 38), 19 with normal parameters in the binocular vision test, and 15 with no symptoms.&#x0D; Conclusions: The frequency of NSBVAs was high among handloom silk weavers compared to the literature. This implies a need for comprehensive binocular vision examination for people in this occupation to rule out NSBVAs for improving their quality of life and occupational productivity. Future large-scale studies are required to determine the exact NSBVAs prevalence among workers of this near vision-related occupation.

Comparing accommodative function between dominant and non-dominant eye

This study aims to compare accommodative functions between the dominant and non dominant eyes.A comparative study done in 50 healthy subjects include both males and females with age group ranging between (18 -25 years). It was a hospital-based study conducted in the outpatient department of Ophthalmology. The comparison of accommodative function between dominant and non-dominant eyes is measured to determine which eye shows a higher level of accommodative function. This study has been approved by IRB committee, before beginning this study informed consent has been given and the procedure has been explained clearly, 50 Young emmetropic adults were included. All participants were subjected to comprehensive ophthalmic examination including vision, refraction, Intraocular pressure measurements, slit-lamp examination, the dominance of eye is determined using the hole in the card method and Accommodative functions like the Monocular estimated method (MEM), Near the point of accommodation (NPA) and Accommodative facility (AF) done to find out the ocular dominance.This study shows a higher level of accommodative function in all aspects of accommodative factor such as Monocular estimated method (MEM), near the point of accommodation (NPA) and accommodative facility in the dominant eye. The Mean and Standard deviation value shows a significant difference in all parameters in the dominant eye with a t-value of 7.055(p=.000) when comparing with the Non dominant eye.Comparing the accommodative function between the Dominant and Non dominant eye we concluded that the Near Point of accommodation and accommodation facility were observed more in the dominant eye as compared with the non dominant eyes. The mean accommodative lead was found to be greater than the normal individual (dominant eye). Hence, it is concluded that the dominant eye has a better accommodative function than the non dominant eye.

Changes to Visual Parameters Following Virtual Reality Gameplay.

Introduction:Virtual reality (VR) gameplay is popular with a range of games and educational resources available. However, it puts high demands on the visual system. Current evidence shows conflicting impacts on visual parameters. Therefore, this study explores the changes to vision following VR gameplay.Methods:The study was conducted at the School of Health Sciences, University of Liverpool. All participants had binocular vision with good visual acuity and no manifest strabismus. Participants were assessed before and after playing 15 minutes of the VR game Beat Saber, which incorporated convergence and divergence movements. Clinical assessments including near point of convergence (NPC) and near point of accommodation (NPA) using the RAF rule; accommodative convergence to accommodation (AC/A) ratio; motor fusion using the prism fusion range (at 33cm), accommodation facility using +2.00/–2.00DS flipper lenses, and stereoacuity using the Frisby stereo test were assessed before and after playing.Results:Seventy-eight participants (19–25 years old) were included in the study, with 16 males and 41 females respectively. The breakpoint of convergence reduced by 0.5 cm (p = 0.001). The binocular accommodative facility improved by 2 cycles per minute (cpm); p = 0.004. The mean, near horizontal prism fusion range (PFR) base break and recovery points both worsened by of 5.0 dioptres (p = 0.003), whereas the mean near horizontal PFR base in recovery point improved by of 4.0 dioptres (p = 0.003).Discussion:The study validated previous findings as VR gameplay over-exercised and fatigued convergence muscles, but to a small degree. The VR experience improved the participants’ ability to change focus quickly and improve accommodation, as well as the divergence function of the eye. However, as the participants were retested directly after the VR gameplay, the findings were limited to short term effects on vision.

Efficacy of Low-dose Atropine Eyedrops in Myopic Progression in Elementary School Children

Purpose: We analyzed the effects of low-dose atropine on myopic progression in elementary schoolchildren aged 6-11 years.Methods: Medical records were retrospectively reviewed before and after 6 months of low-dose atropine eyedrops. Myopia was defined as a spherical equivalent &lt; -1 diopter. Low-dose atropine eyedrops (atropine sulfate 0.125% [w/v]) and artificial tear eyedrops (sodium hyaluronate 0.1% [w/v]) immediately afterwards were applied to both eyes daily, and all children regularly visited us for measurement of refractive power, axial length, pupil diameter, and near-point accommodation. symptoms (headache, light sensitivity, near-work disturbance, allergic reaction, dry eye, and poor night vision) were recorded.Results: A total of 116 patients were included. Atropine was prescribed for 65 patients, the remaining 51 patients constituted the control group. In the atropine group, the mean age was 10.2 ± 1.8 years and 23 patients (35.4%) were male. At the initial visit, the mean refractive power was -4.7 ± 2.1 diopters (D) (-1.0 to -10.5) and the mean axial length was 24.95 ± 1.02 mm (22.58-27.99). At the 6-month follow-up, the change of refractive power was -0.9 ± 1.1 D (-0.75 to -4.75) and the change of axial length was 0.47 ± 0.39 mm (0.01-1.6). However, 6 months after application of low-dose atropine eyedrops, the change of refractive power was -0.1 ± 0.2 D (0 to -0.25) and the change of mean axial length was 0.15 ± 0.23 mm (0-1.05). The mean pupil diameter was 6.7 ± 0.6 mm (5.3-9.3) and the near accommodation point was 6.1 ± 2.0 cm (3.1-11.0). Two patients (3.1%) complained of near-work disturbance but none stopped taking the eyedrops.Conclusions: Significant decreases in the changes of refractive power and axial length were evident in myopic elementary schoolchildren after low-dose atropine therapy. Low-dose atropine attenuates myopic progression without severe complications.

A Novel Intraocular Lens Simulator that Allows Patients to Experience the World Through Multifocal Intraocular Lenses Before Surgeries.

PurposeThe purpose of this study was to investigate whether the intraocular lens (IOL) simulator can simulate how the world appears to patients with multifocal IOLs by allowing the patients to see far and near objects through the IOL simulator.MethodsTwenty eyes from 20 patients (age = 50–70 years old) were included in the study. The IOL simulator we developed consists of a trial lens frame adapter, a lens tube, a concave lens, a spacer, a wet cell, and an IOL. We used two IOLs: Tecnis monofocal and Tecnis bifocal IOL (add +3.25 diopter [D]). Patients wore a trial lens frame with an IOL simulator on distant corrected trial lenses and underwent the following tests: defocus curve, satisfaction with distance and near vision, halo around the light, and near point accommodation (NPA). To check how the world appears to the patients through this simulator, a machine vision lens and a scientific camera were attached to the simulator, and far and near objects were photographed.ResultsIn the defocus curve of multifocal IOL, the visual acuity showed the second peak at –4 D. Compared to monofocal IOL, satisfaction with distant vision was slightly worse, more halos were felt, satisfaction with near vision was higher, and the NPA was shorter in multifocal IOL. In the scientific camera test, through the multifocal IOL, the waiting room was blurry, the halo around the ceiling light was prominent, and the characteristics on the near visual acuity chart were clear.ConclusionSubjects could experience the functions of multifocal IOLs with our newly developed IOL simulator.Translational RelevanceThis IOL simulator using geometric optics allows patients to experience the function of multifocal IOLs before cataract surgery.

Effect of vision therapy on fusional vergences in intermittent exotropia

Significance: Intermittent exotropia is intermittently manifest squint at distance and latent exophoria at near. Most of the time, the eyes seems to be aligned with normal binocular single vision is maintained because its exodeviation is intermittently controlled by fusional mechanisms. Purpose: To evaluate the effect of vision therapy on fusional vergences in intermittent exotropia. Methods: This hospital-based, Quasi-Experimental study was carried out at the Orthoptics clinic of Al-Ibrahim Eye Hospital from August 2020 to July 2021. Non- probability, purposive sampling was used. This study involved the 40 subjects who were diagnosed with Intermittent Exotropia of age ranges 10 to 25 years, of both genders. A detailed history was evaluated. Orthoptics assessment included visual acuity, cover test, near the point of accommodation and convergence at a distance, and near and fusional vergences of positive and negative with prisms were measured. All subjects underwent vision therapies for 2 months. SPSS version 20.0 was used to analyze the data. Results: A total of 40 subjects with a mean age of 16.53±2.96 were included in this study. Out of 40 subjects, 22 subjects were females and 18 subjects were males. Subjects who received dot card therapy and executives bifocals therapy showed a significant change in the angle of deviation at distance and near (P=.001), followed by reduced the near point of convergence (P=.001), and increased the positive fusional vergences at distance and near (P=.001). There was no significant improvement seen in near point of accommodation (P=.16) with both therapies. Negative fusional vergences showed non-significant as (near: P=.14, distance: P=.05) with executives bifocals and (P=.26) with dot cards. Conclusions: This study showed that vision therapies with dot card and executive bifocals therapy have significantly improved the angle of deviation, positive fusional vergences, and near point of convergence in intermittent exotropia subjects.

Atropine in myopia – Does it reduce progression? Results of Phase 1 clinical trial in children attending a tertiary eye care center in South India

Aim: The aim of this study was to analyze the effectiveness of low-dose atropine (0.01%) in reducing the progression of myopia in Indian children. Materials and Methods: This was a clinical trial of Indian children with axial myopia from January 2018 to May 2019, who were prescribed low-dose atropine (0.01%) to reduce progression. Parameters studied before and after starting low-dose atropine were as follows: visual acuity for distance and near, cycloplegic refraction, ocular alignment for distance and near, near point of accommodation (NPA), near point of convergence, axial length (AXL), pupil diameter (PDM), lens thickness (LT), anterior chamber depth (ACD), adverse reaction, compliance, and dropouts. Patients were evaluated at the initiation of treatment, at 1 month, and thereafter 6 monthly with a minimum follow-up of 6 months. Any increase in spherical equivalent (SE) of myopia was taken as progression and rapid progression of myopia was considered if there was a ≥0.5 DS increase in SE of myopia within 6 months. Results: Seventy-one eyes of 36 children who opted for low-dose atropine (18 males and 18 females) and 37 eyes of 19 age-matched children (10 females and 9 males) were included in the final study and control groups, respectively. The mean age was 8.31 years (standard deviation [SD] =1.191) in the cases compared to 9.68 years (SD = 3.606) in the controls. Progression of myopia was noted in 40 eyes (56.338%) in the study group as compared to 35 eyes (94.59%) in the control group (P = 0.00). Rapid progression was noted in 23 eyes (32.39%) in the study group as compared to 23 eyes (62.16%) in the control group (P = 0.003). The mean SE of myopia increased by 0.28 D (as compared to 0.63 D increase among the controls) (P = 0.01), and the mean AXL increased by 0.14 mm (as compared to 0.25 mm among the controls) in the study group at the end of 6 months (P = 0.01). There was also a statistically significant increase in mean PDM by 0.83 mm (P = 0.01) and receding of mean NPA by 1.14 cm in cases (P = 0.03). However, these changes were clinically insignificant. No significant changes were noted in ACD, LT, NPC, and ocular alignment. No adverse reactions were reported. Conclusion: Low-dose atropine (0.01%) therapy was able to reduce the progression of myopia in the study group as compared to the controls with a good tolerance and no change in the vision-related quality of life. Long-term follow-up is, however, needed for extrapolation into the general population.

Distribution of near Point of Convergence, near Point of Accommodation, Accommodative Facility and Refractive Errors in a Rural Population Living in Northern Iran

ABSTRACT Purpose: To evaluate near point of convergence (NPC), near point of accommodation (NPA), and accommodative facility (AF) in order to determine their normative data in a rural population. Methods: The target population for this population-based, cross-sectional study was people living in rural areas. Each subject underwent extensive optometric and ophthalmic examinations, including the measurement of visual acuity, refraction, NPA, NPC, and AF. Results: The data of 1113 individuals was analyzed of whom 58.8% (n = 576) were women. The mean age of the participants was 15.26 ± 7.38 years (range: 6–30 years). The mean spherical equivalent of the subjects was 0.16 ± 0.63 D. The prevalence of myopia, hyperopia and astigmatism was 16.28% (13.97–18.58), 5.97% (4.49–7.44), 11.93% (9.91–13.95) in this study, respectively The mean and 95% confidence interval of NPC, NPA, and binocular accommodative facility (BAF) was 6.99 cm (6.84–7.15), 9.91 cm (9.71–10.11), and 9.84 cpm (9.63–10.06), respectively. A significant correlation was found between age and the parameters such that all evaluated parameters worsened significantly with age (P < .001). Conclusion: The results of the present study showed the normal ranges of NPA, NPC, and BAF in a 6–30 year-old population living in rural areas of northern Iran. These parameters changed significantly with age.