Research Review

Accommodation and Vergence in Children Using Atropine with Orthokeratology

June 15, 2022

By Dwight Akerman, OD, MBA, FAAO, FBCLA, FIACLE

A common question from myopia management clinicians is: Does topical low-dose atropine combined with orthokeratology significantly affect binocular vision measurements? To help answer this question, Jiang et al. conducted a prospective randomized controlled clinical trial to evaluate binocular vision in terms of vergence and accommodative measurements in children treated with 0.01% atropine combined with orthokeratology (OK).

Participants aged 8 to 12 years with a spherical equivalent (SE) ranging from -1.00D to -6.00D were randomly divided into four groups: 1) a combination group using 0.01% atropine solution and OK lens; 2) an OK group using placebo solution and OK lens; 3) an atropine group using 0.01% atropine solution and wearing spectacles; and 4) a control group using placebo solution and wearing spectacles.

Binocular vision was determined at baseline and three-month visits, with evaluations including horizontal phoria, fusional vergence, the accommodative convergence/accommodation (AC/A) ratio, accommodative lag, and accommodative amplitude (AA).

There was no significant difference in baseline refraction, accommodation, or vergence measurements among the groups (all P > 0.05). Three months later, the accommodative lag significantly decreased in the OK group (P = 0.002) but remained unchanged in the other three groups (all P > 0.05). In addition, binocular accommodative facilities and positive relative accommodations increased in the combination and OK groups (both P < 0.05) but remained unchanged in the atropine and control groups (both P > 0.05). Only the participants with esophoria in the OK group had a significant decrease in esophoria (P = 0.008).

The authors conclude that accommodative measurements changed similarly in the groups treated with OK, and changes in vergence measurements after treatment with 0.01% atropine were insignificant.

The conclusions of this study are supported by recent research into binocular vision and low-dose atropine presented at the ARVO 2022 meeting by Breliant et al

Abstract

Accommodation and Vergence Function in Children Using Atropine Combined with Orthokeratology 

Jinyun JiangWen LongYin HuFeng ZhaoWenchen ZhaoBingru ZhengZhibin FengZhouyue Li Xiao Yang 

Purpose: This study aimed to evaluate binocular vision in terms of vergence and accommodative measurements in children treated with 0.01% atropine combined with orthokeratology (OK). 

Methods: This was a prospective and randomized controlled clinical trial involving participants aged 8 to 12 years, with a spherical equivalent (SE) ranging from -1.00 to -6.00D. Participants were randomly divided into four groups: 1) a combination group using 0.01% atropine solution and OK lens; 2) an OK group using placebo solution and OK lens; 3) an atropine group using 0.01% atropine solution and wearing spectacles, and 4) a control group using placebo solution and wearing spectacles. Binocular vision was determined at baseline and 3-month visits, with evaluations including horizontal phoria, fusional vergence, the accommodative convergence/accommodation (AC/A) ratio, accommodative lag, and accommodative amplitude (AA). The Wilcoxon signed-rank test was used to compare the changes in binocular vision in each group, and the Kruskal-Wallis test was used for comparisons of four groups. 

Results: Sixty-two participants completed the study. There was no significant difference in baseline refraction, accommodation, or vergence measurements among the groups (all P > 0.05). Three months later, the accommodative lag significantly decreased in the OK group (P = 0.002) but remained unchanged in the other three groups (all P > 0.05). In addition, binocular accommodative facilities and positive relative accommodations increased in the combination and OK groups (both P < 0.05) but remained unchanged in the atropine and control groups (both P > 0.05). Only the participants with esophoria in the OK group had a significant decrease in esophoria (P = 0.008). Moreover, the changes in fusional vergence and AC/A did not significantly differ between the four groups (all P > 0.05). 

Conclusion: Accommodative measurements changed similarly in the groups treated with OK. Changes in vergence measurements after treatment with 0.01% atropine were not significant. 

Jiang, J., Long, W., Hu, Y., Zhao, F., Zhao, W., Zheng, B., … & Yang, X. (2022). Accommodation and vergence function in children using atropine combined with orthokeratology. Contact Lens and Anterior Eye, 101704.

DOI:https://doi.org/10.1016/j.clae.2022.101704

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