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Effect of Vision Therapy on Accommodative Lag in Myopic Children

A Randomized Clinical Trial

Ma, Martin Ming-Leung, BSc1; Shi, Jingcheng, Dip1; Li, Na, Dip1; Scheiman, Mitchell, OD, PhD, FAAO2*; Chen, Xiang, MS, PhD1*

doi: 10.1097/OPX.0000000000001316

SIGNIFICANCE Accommodative dysfunction has been suggested to be related to the development and progression of myopia. Office-based accommodative/vergence therapy (OBAVT) improved accommodative facility in Chinese myopic children, but it is unclear if such improvement has a role in decreasing myopic progression.

PURPOSE The purpose of this study was to compare the effects of OBAVT with home reinforcement and office-based placebo therapy (OBPT) as a treatment to improve accommodative functions (i.e., lag, amplitude, and facility) in myopic children with poor accommodative accuracy.

METHODS This was a prospective, single-masked, randomized clinical trial. Thirty-four Chinese children 8 to 12 years old with myopia and at least 1 diopter of lag of accommodation measured by autorefraction were enrolled. The participants were randomly assigned to the OBAVT or OBPT group. The primary outcome measure was the change in the monocular lag of accommodation from the baseline visit to the 13-week visit measured by a Shin-Nippon open-field autorefractor. Secondary outcome measures were changes in accommodative amplitude and monocular accommodative facility.

RESULTS A total of 33 participants completed the study. After 12 weeks of treatment, there were significant improvements in the lag of accommodation in both the OBAVT and OBPT groups (OBAVT: −0.30 ± 0.29 diopters [P < .001; Cohen’s d effect size, 1.29]; OBPT: −0.24 ± 0.30 diopters [P = .005; Cohen’s d effect size, 1.24]). There was no statistically significant difference between the improvements in the two groups (P = .50). There was statistically significant improvement in monocular accommodative facility only in the OBAVT group (OBAVT: 7.7 ± 4.7 cycles per minute [P < .001; Cohen’s d effect size, 2.20]; OBPT: 1.9 ± 4.4 cycles per minute [P = .072]). The change in the OBAVT group was statistically significantly larger than that in the OBPT group (P < .001).

CONCLUSIONS Office-based accommodative/vergence therapy was no more effective than OBPT in reducing the lag of accommodation in children 8 to 12 years old with low to moderate myopia. It did improve accommodative facility in Chinese myopic children, but it is unclear if such an improvement has a role in decreasing myopic progression.

1State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China

2Pennsylvania College of Optometry at Salus University, Philadelphia, Pennsylvania *;

Submitted: June 28, 2017

Accepted: July 22, 2018

Funding/Support: Science and Technology Program of Guangdong Province, China (2013B020400003; to XC) and Science and Technology Program of Guangzhou, China (15570001; to XC).

Conflict of Interest Disclosure: None of the authors have reported a financial conflict of interest.

Study Registration Information: Trial Registration Database: Trial Registration No.: NCT03006601. Date of Registration: October 28, 2016.

Author Contributions and Acknowledgments: Conceptualization: MM-LM, MS, XC; Data Curation: MM-LM; Formal Analysis: MM-LM; Funding Acquisition: XC; Investigation: MM-LM, JS, NL; Methodology: MM-LM, MS, XC; Project Administration: MM-LM, JS, NL, XC; Resources: XC; Supervision: MM-LM, XC; Writing – Original Draft: MM-LM; Writing – Review & Editing: MM-LM, MS, XC.

The authors thank Cuiyun Su, Chao Chen, and Juncheng Wang, who conducted the examinations and vision therapy; Nancy Lin, who assisted with project coordination; and Jian Zhang, who assisted with data analysis.

© 2019 American Academy of Optometry