Clinical Efficacy of Home Accommodation Training Based on Monocular Exposure with Negative Lenses with Exponentially Increasing Power

Purpose. To study the clinical efficacy of home accommodation training based on monocular exposure to negative lenses with exponentially increasing power.

Materials and methods. We observed 64 patients aged 20 to 30 years with visually demanding work (VDV). They were divided into two groups of equal age and uncorrected distance visual acuity (UDVA). These groups met the diagnostic criteria for habitual excessive accommodation strain (HEAS, 33 patients) and asthenic form of accommodative asthenopia (AFAA, 31 patients). The home training method was carried out using the mini-trainer “Okos” developed by the author, based on the monocular effect of 7 negative lenses with an exponentially increasing power (sph: -1.0; -1.5; -2.5; -4.25; -7.0; -9.0; -12.0 D). Examination of the patients’ vision was performed before and after the end of the home training course based on the values of the UCVA, the absolute accommodation volume (AAV), the relative accommodation reserve (RAR), as well as the patient’s assessment of the “feeling of eye fatigue” (on a 10-point scale).

Results and discussion. Conducting home training is a fairly effective method, which is confirmed by the restorative correction of the leading functional disorders in patients with accommodative asthenopia (with AFAA — an increase in the AAV by an average of 3.5 D (p < 0.001), with HEAS — an increase in the RAR by an average of 2.6 D (p < 0.001), while in both cases, the specified indicators after the training course corresponded to the normative age values. The described positive dynamics is confirmed by an increase in the uncorrected visual acuity (by 0.17–0.18 relative units, p < 0.05) and a significant decrease in subjective “eye fatigue” (by 4.0–4.6 points, p < 0.001). The main advantages of the proposed home training method are the exposure mode, which corresponds to the physiology of the ciliary muscle with the highest possible speed close to the exponential law and short exposure, which is an effective prevention of severe muscle fatigue.

Conclusion. The described clinical efficacy, low cost, and small weight and dimensions allow for the widespread use of the proposed “Okos” mini-trainer in patients VDV as maintenance therapy following an outpatient course of hardware-based rehabilitation.

1. Proskurina OV, Tarutta EP, Iomdina EN, Strakhov VV, Brezhsky VV. A modern classification of asthenopias: clinical forms and stages. Russian Ophthalmological Journal. 2016;9(4):69–73 (In Russ.). doi: 10.21516/2072-0076-2016-9-4-69-73.

2. Шаповалов СЛ, Милявская ТИ, Игнатьев СА. Основные формы астенопии. М.: Мик, 2012:288. Shapovalov SL, Milyavskaya TI, Ignatiev SA. The main forms of asthenopia. Moscow: Mick, 2012:288 (In Russ.).

3. Ovechkin IG, Grishchenko IV. On the issue of classification signs of asthenopia. Modern optometry. 2017;5(105):8–9 (In Russ.).

4. Yudin VE, Yaroshenko VP, Belikova EI, Gatilov DV, Ovechkin IG, Kosukhin ES. Methodological principles of medical rehabilitation of patients with visually intense work with accommodative asthenopia after excimer laser correction of myopia. Bulletin of the Medical Institute of Continuous Education. 2023;3(2):64–69 (In Russ.). doi: 10.36107/2782-1714_2023-3-2-64-69.

5. Belikova EI, Gatilov DV, Ovechkin IG Eskina EN. Excimer Laser Correction of Myopia in Patients with Visually Intense Work — Is It Necessary to Determine the Form of Accommodative Asthenopia? Ophthalmology in Russia. 2023;20(2):276– 282 (In Russ.). doi: 10.18008/1816-5095-2023-2-276-282.

6. Аккомодация: руководство для врачей под ред. Л.А. Катаргиной. М.: Апрель, 2012:136. Accommodation: a guide for doctors, ed. L.A. Katargina. Moscow: April, 2012:136 (In Russ.).

7. Morimoto T, Kanda H, Hirota M, Nishida K, Fujikado T. Insufficient accommodation during binocular near viewing in eyes with intermittent exotropia. Jpn J Ophthalmol. 2020 Jan;64(1):77–85. doi: 10.1007/s10384-019-00695-2.

8. Ovechkin IG, Gadzhiev IS, Kozhukhov AA, Belikova EI. Diagnostic criteria for the asthenic form of accommodative asthenopia in patients with computer vision syndrome. Clinical ophthalmology. 2020;20(4):169–174 (In Russ.). doi: 10.32364/23117729-2020-20-4-169-174.

9. Ovechkin IG, Gadzhiev IS, Kozhukhov AA, Belikova EI. Optical Reflex Treatment of Myopia and Asthenic Form of Accommodation Asthenopia Form the Standpoint of the Methods Used, Effectiveness and Staging. Ophthalmology in Russia. 2020;17(3):422–428 (In Russ.). doi: 10.18008/1816-5095-2020-3-422-428.

10. Allen PM, Radhakrishnan H, Rae S, Calver RI, Theagarayan BP, Nelson P, Osuobeni E, Sailoganathan A, Price H, O’Leary DJ. Aberration control and vision training as an effective means of improving accommodation in individuals with myopia. Invest Ophthalmol Vis Sci. 2009 Nov;50(11):5120–5129. doi: 10.1167/iovs.08-2865.

11. Ma MM, Scheiman M, Su C, Chen X. Effect of Vision Therapy on Accommodation in Myopic Chinese Children. J Ophthalmol. 2016;2016:1202469. doi: 10.1155/2016/1202469.

12. Allen PM, Charman WN, Radhakrishnan H. Changes in dynamics of accommodation after accommodative facility training in myopes and emmetropes. Vision Res. 2010 May 12;50(10):947–955. doi: 10.1016/j.visres.2010.03.007.

13. Iomdina EN, Bauer SM, Kotlyar KE. Biomechanics of the eye: theoretical aspects and clinical applications. Ed. by VV Neroev. Moscow: Real Time, 2015:208 (In Russ.).

14. Xu-Friedman MA, Regehr WG. Structural contributions to short-term synaptic plasticity. Physiol Rev. 2004 Jan;84(1):69–85. doi: 10.1152/physrev.00016.2003.

15. Strakhov VV, Klimova ON, Korchagin NV. The clinical picture of active accommodation for far vision. Russian Ophthalmological Journal. 2018;11(1):42–51 (In Russ.). doi: 10.21516/2072-0076-2018-11-1-42-51.