title: Training regimen involving cyclic induction of pupil constriction during far accommodation improves visual acuity in myopic children.
abstract: OBJECTIVE
  Myopia in school-age children has become increasingly prevalent in industrialized countries, especially in Asia. A large population of school-age children still suffers from low visual acuity. We have developed a novel, safe and noninvasive training method to activate a pupillary constriction response during far accommodation that results in improved visual acuity.
  
  
  METHODS
  Myopic children (n = 95) were treated for 3-minute sessions up to twice a week for 12-106 weeks. We stimulated quick cycles of near/far accommodation by displaying a visual object on a LCD screen and moving the screen in cycles from a near (25 cm) to a far (70 cm) point and back, while keeping the retinal projection size and brightness of the object constant.
  
  
  RESULTS
  Mechanistically, we noted pupillary constriction upon far accommodation in trained myopic children, which was not seen in normal subjects or in untrained myopic children. Eighty five percent (52/61) of trained myopic right eyes with two sessions weekly experienced improved visual acuity (VA) by more than 0.1 logMAR units with an average improvement of 0.30 +/- 0.03 standard error of mean (SEM) logMAR units. With maintained training, most eyes' improved VA stayed almost constant, for more than 50 weeks in the case of 12 long trained subjects.
  
  
  CONCLUSIONS
  This simple, short and safe accommodation training greatly improves the quality of vision in a large population suffering from refractive abnormalities.
authors.affiliation: Kikuna Yuda Eye Clinic, Yokohama, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yuda
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Uozato
authors.forename: Naoto
authors.initials: N
authors.lastname: Hara
authors.forename: Wolfram
authors.initials: W
authors.lastname: Tetzlaff
authors.forename: Satoru
authors.initials: S
authors.lastname: Hisahara
authors.forename: Hiroko
authors.initials: H
authors.lastname: Horie
authors.forename: Satomi
authors.initials: S
authors.lastname: Nakajima
authors.forename: Hidenori
authors.initials: H
authors.lastname: Horie
references.citation: Br J Ophthalmol. 2005 Nov;89(11):1489-94
references.pmid: 16234459
references.citation: Invest Ophthalmol Vis Sci. 2003 Apr;44(4):1492-500
references.pmid: 12657584
references.citation: Vision Res. 2006 Oct;46(20):3443-50
references.pmid: 16806388
references.citation: Arch Ophthalmol. 2008 Aug;126(8):1111-9
references.pmid: 18695106
references.citation: Invest Ophthalmol Vis Sci. 1988 Nov;29(11):1739-46
references.pmid: 3182206
references.citation: J Physiol. 1993 Feb;461:301-20
references.pmid: 8350267
references.citation: Am J Optom Arch Am Acad Optom. 1951 Jul;28(7):347-56
references.pmid: 14846894
references.citation: J Refract Surg. 2003 Mar-Apr;19(2 Suppl):S270-4
references.pmid: 12699188
references.citation: Ophthalmic Physiol Opt. 2007 Jul;27(4):353-60
references.pmid: 17584286
references.citation: Ophthalmic Physiol Opt. 2002 May;22(3):175-82
references.pmid: 12090630
references.citation: Vision Res. 2008 Mar;48(8):989-93
references.pmid: 18316106
references.citation: Invest Ophthalmol Vis Sci. 2004 Oct;45(10):3620-8
references.pmid: 15452069
references.citation: Invest Ophthalmol Vis Sci. 2002 Sep;43(9):2852-8
references.pmid: 12202502
references.citation: Am J Optom Physiol Opt. 1987 Jul;64(7):482-98
references.pmid: 3307440
references.citation: Optom Vis Sci. 2004 Sep;81(9):657-62
references.pmid: 15365384
references.citation: Hum Factors. 1987 Jun;29(3):311-25
references.pmid: 3623566
references.citation: Invest Ophthalmol Vis Sci. 1999 Aug;40(9):1968-74
references.pmid: 10440250
references.citation: Surv Ophthalmol. 1999 Oct;44 Suppl 1:S109-115
references.pmid: 10548123
references.citation: Vision Res. 1992 Sep;32(9):1775-9
references.pmid: 1455749
references.citation: Ophthalmic Physiol Opt. 2001 Mar;21(2):87-100
references.pmid: 11261351
references.citation: Trans Am Ophthalmol Soc. 2007;105:132-8; discussion 138-40
references.pmid: 18427602
references.citation: Ophthalmic Physiol Opt. 2009 Jan;29(1):72-9
references.pmid: 19154283
references.citation: Am J Optom Physiol Opt. 1976 Nov;53(11):740-5
references.pmid: 998716
references.citation: Ann Acad Med Singap. 2004 Jan;33(1):27-33
references.pmid: 15008558
references.citation: Am J Ophthalmol. 2004 Jul;138(1):70-8
references.pmid: 15234284
references.citation: Invest Ophthalmol Vis Sci. 2005 Jan;46(1):51-7
references.pmid: 15623754
references.citation: Invest Ophthalmol Vis Sci. 2006 Apr;47(4):1334-8
references.pmid: 16565365
references.citation: Invest Ophthalmol Vis Sci. 2007 Feb;48(2):562-70
references.pmid: 17251451
references.citation: Optom Vis Sci. 2006 May;83(5):306-10
references.pmid: 16699443
references.citation: Invest Ophthalmol Vis Sci. 2007 Jun;48(6):2932-9
references.pmid: 17525230
references.citation: Optom Vis Sci. 1999 Jun;76(6):370-80
references.pmid: 10416931
references.citation: Surv Ophthalmol. 2006 Jan-Feb;51(1):75-85
references.pmid: 16414364
references.citation: Arch Ophthalmol. 2004 Apr;122(4):495-505
references.pmid: 15078666
references.citation: Ophthalmology. 2006 Dec;113(12):2285-91
references.pmid: 16996612
references.citation: J Am Optom Assoc. 1996 Dec;67(12):749-54
references.pmid: 9286316
references.citation: Proc Natl Acad Sci U S A. 1994 Feb 15;91(4):1206-9
references.pmid: 8108388
references.citation: Invest Ophthalmol Vis Sci. 2008 Jul;49(7):2781-9
references.pmid: 18579755
references.citation: J Physiol. 1966 Oct;186(3):558-78
references.pmid: 5972153
references.citation: Nat Neurosci. 2009 May;12(5):549-51
references.pmid: 19330003
references.citation: Vision Res. 1991;31(2):267-73
references.pmid: 2017887
references.citation: Curr Opin Neurobiol. 1996 Apr;6(2):269-74
references.pmid: 8725971
references.citation: Am J Optom Physiol Opt. 1979 Aug;56(8):490-503
references.pmid: 543495
references.citation: Vision Res. 2006 Apr;46(8-9):1507-19
references.pmid: 16384590