Correlation Between Binocular Vision Function and Visual Fatigue in School-Age Children With Myopic Anisometropia

Correlation Between Binocular Vision Function and Visual Fatigue in School-Age Children With Myopic Anisometropia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Correlation Between Binocular Vision Function and Visual Fatigue in School-Age Children With Myopic Anisometropia Yingpin Cao, Jiajia Ye, Aiqin Nie, Dan Sun, Ming-ming Yang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6029915/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 20 May, 2025 Read the published version in Scientific Reports → Version 1 posted 4 You are reading this latest preprint version Abstract This study investigated differences in binocular vision and visual fatigue between school-aged children with myopic anisometropia and myopic isometropia. It also examined the correlation between myopic anisometropia and binocular vision parameters. One hundred school-aged (ages 6-13 years) children (43 boys and 57 girls) were divided into two groups: the myopic anisometropia group (interocular spherical equivalent difference ≥1.50 D and <4.00 D) and the myopic isometropia group as control group (interocular spherical equivalent difference <1.00 D). Binocular vision parameters related to accommodation were analyzed, including accommodative amplitude, flexibility, relative accommodation, and convergence flexibility. Differences in visual fatigue scores between groups were also evaluated. The myopic anisometropia group had significantly lower accommodative amplitude, flexibility, and convergence flexibility compared to the control group. Visual fatigue scores were higher in the myopic anisometropia group, and scores were negatively correlated with convergence flexibility (P<0.001). Additionally, fatigue scores were negatively correlated with accommodative facility in the control group. There is a correlation between the change in binocular vision function parameters and myopic anisometropia. Moreover, the combination of myopia and anisometropia has a compounding effect, making binocular vision dysfunction and visual fatigue more likely to occur compared to myopia without anisometropia. Health sciences/Health care Health sciences/Medical research anisometropia visual function myopia eye fatigue Introduction Anisometropia refers to a significant difference in refractive power between the two eyes in one or more main meridians [1] . Various factors, including genetics, gender, age, environmental factors, education level, and ethnicity, can influence the development of anisometropia [2] . Anisometropia exceeding 2.50 D disrupts binocular fusion, impairing the brain's ability to integrate disparate retinal images into a coherent stereoscopic perception. This breakdown in binocularity manifests clinically as diplopia, visual fatigue, and dyslexia-related symptoms, significantly compromising patients' quality of life and cognitive performance [3,4] . The pathophysiology involves a hierarchical cascade of neural adaptations: once the interocular refractive difference surpasses fusion thresholds (spherical difference ≥1.50 D or cylindrical ≥1.00 D), a consequential retinal image disparity exceeding 5% triggers synaptic plasticity-mediated suppression of the defocused eye's input. At the cellular level, this results in lateral geniculate nucleus (LGN) neuronal atrophy and hypoactivation of primary visual cortex regions V1-V3, establishing contralateral monocular dominance. Chronic cortical inhibition progressively reduces binocular neuron populations from 70% to 30%, while concomitant disruption of superior colliculus-frontal eye field circuitry impairs vergence control. If left untreated, prolonged suppression of the weaker eye can lead to anisometropic amblyopia, with approximately one-third of cases progressing to strabismus due to irreversible reorganization of binocular integration pathways. Zhuang et al. previously grouped myopic anisometropia in 8-15 year old children by degree of anisometropia to analyze the accommodative and binocular visual function [ 5 ] . This clinical study was more descriptive, but did not delve into the relationship between anisometropia and visual fatigue. In recent years, the prevalence of myopia among school-aged children in China has increased sharply, with an earlier onset and faster progression [6,7]. Therefore, in this study, we focused on school-age (6-13 years old) children with minimal age variation and rapid myopia progression. The children were grouped into those with myopic isometropia or myopic anisometropia (controls). Each child completed a questionnaire on eye fatigue and also had their binocular vision function measured. This allowed us to not only confirm the impact of anisometropia on binocular visual dysfunction but also establish a clear correlation between binocular vision parameters and visual fatigue. By translating these theoretical findings into clinical practice, our study provides new guidance for individualized management of anisometropia-related asthenopia. Specifically, the strong association between convergence flexibility and visual fatigue suggests that targeted vision therapy and optical interventions may help alleviate symptoms, offering a more precise and symptom-driven approach to managing anisometropia in children Results Population A total of 100 eligible participants were enrolled, of whom 50 participants (23 boys, 27 girls) were in the myopic anisometropia group ，the mean age was 9.95±1.12 years. No significant difference was found in age or sex among the two groups (all P > 0.05). However, significant differences were found in spherical equivalent refraction (P < 0.05). The demographics of the participants in the two groups are detailed in Table 1 . Table 1. Basic Characteristics of the Myopia Anisometropia Group and the Control Group ( n =100) The myopic anisometropia group The myopic isometropia Group Gender, n (%) Male 23(46.0) 20(40.0) Female 27(54.0) 30(60.0) Age (years), Mean ± SD 10.40±1.85 9.44±1.99 Right eye Sph, Median ( min , max ) -2.13(-4.50,1.50) -1.25(-4.00,0.00) Right eye Cyl, Median ( min , max ) -0.50(-2.50,0.00) -0.25(-1.25,0.00) Left eye Sph, Median ( min , max ) -0.75(-3.50,1.00) -1.25(-4.25,0.00) Left eye Cyl, Median ( min , max ) -0.50(-3.00,0.00) -0.50(-1.50,0.50) Sph:Spherical lens; Cyl:Cylinder lens SD:Standard deviation; Min:Minimum; Max:Maximum Comparison of the accommodation-related binocular function parameters between groups The accommodation-related binocular visual function parameters in both groups did not follow a normal distribution; therefore, the non-parametric Wilcoxon rank sum was performed. The accommodative amplitude (AMP), accommodative facility (AF), and convergence facility (CF) of the myopic anisometropia group were significantly lower than those of the control group. There was no significant difference in negative relative accommodation (NRA) between the two groups (see Table 2). Comparison of the results of the ASQ-11 between the two groups The asthenopia scale questionnaire ASQ-11 scores of the two groups also did not follow a normal distribution so the Wilcoxon rank sum test was conducted. The ASQ-11 score in the anisometropia group was significantly higher than that in the control group (see Table 2). Table 2. Comparison of Accommodative Binocular Visual Function and Eye Fatigue Questionnaire (ASQ-11) Scores between Groups Myopic Anisometropia Group, Median(min,max) The myopic isometropia Group Median(min,max) Z value P value AMP Right eye 7.00 (2.50, 16.75) 12.00 (4.00, 24.50) -4.520 <0.001 Left eye 6.00 (2.50, 14.50) 12.00 (2.50, 20.25) -4.735 <0.001 AF Right eye 2.00 (0.00, 13.00) 9.75 (0.50, 15.00) -5.196 <0.001 Left eye 2.75 (0.00, 13.00) 9.75 (0.50, 17.50) -5.263 <0.001 Binocular 2.50 (0.00, 13.50) 9.00 (0.50, 15.50) -5.178 <0.001 PRA -1.00 (-9.50, 0.00) -2.00 (-7.00, 0.00) -2.674 0.008 NRA 2.50 (0.00, 3.25) 2.50 (0.00, 2.75) -1.018 0.309 CF 9.75 (2.50, 20.00) 12.75 (4.50, 19.50) -3.433 0.001 ASQ-11 13.00 (5.00, 19.00) 6.50 (3.00, 15.00) -5.839 <0.001 AMP:Accommodative Amplitude; AF:Accommodative Facility PRA:Positive Relative Accommodation; NRA:Negative Relative Accommodation CF:Convergence Facility; ASQ-11:Asthenopia Scale Questionnaire Correlation analysis of visual fatigue parameters and accommodation-related binocular visual function parameters Since the visual fatigue parameters and accommodative binocular visual function parameters did not follow a normal distribution, the correlation between these parameters was evaluated by calculating the Spearman correlation coefficient. Coefficients were calculated for the two groups, and the results showed that the scores of the ASQ-11 in both groups were negatively correlated with the convergence flexibility to a medium to high degree (P<0.001). ASQ-11 scores in both the myopic anisometropia group and the control group were significantly negatively correlated with convergence facility. (see Table 3). Table 3. Correlation Analysis Between Visual Fatigue Parameters and Accommodative Binocular Vision Parameters Binocular Vision Parameters Myopic Anisometropia Group Myopic isometropia Group Spearman Correlation Coefficient P value Spearman Correlation Coefficient P value AMP Right eye 0.055 0.703 -0.234 0.102 Left eye 0.091 0.532 -0.190 0.187 AF Right eye -0.266 0.062 -0.332 0.018 Left eye -0.240 0.093 -0.301 0.034 Binocular -0.037 0.800 -0.295 0.037 PRA -0.035 0.808 0.082 0.572 NRA -0.173 0.229 0.155 0.283 CF -0.785 <0.001 -0.554 <0.001 AMP:Accommodative Amplitude; AF:Accommodative Facility PRA:Positive Relative Accommodation; NRA:Negative Relative Accommodation CF:Convergence Facility Discussion Previous studies have consistently reported that anisometropia can disrupt binocular vision by impairing fusion, stereopsis, and vergence function. Research by Horwood and Riddell highlighted that anisometropia, particularly in myopic patients, is associated with reduced accommodative accuracy and vergence stability [8] . Similarly, Chen et al. found that myopic anisometropia contributes to decreased accommodative amplitude and facility, reinforcing the notion that accommodative control is compromised in these individuals [9] . Our study extends these findings by demonstrating that myopic anisometropia can not only reduce accommodative facility but also negatively affect convergence flexibility, which has been less frequently examined in prior research. This underscores the broader impact of myopic anisometropia on dynamic binocular vision function beyond what has been previously documented. Sheedy et al. established that symptoms of asthenopia are frequently associated with vergence instability and reduced accommodative function [10] . Zhuang et al. primarily focused on accommodative and binocular vision function in children with myopic anisometropia but did not explore its relationship with visual fatigue. Our study provides new insights by revealing that visual fatigue scores are significantly correlated with convergence flexibility in the myopic anisometropia group (P<0.001), highlighting a specific mechanistic relationship that has not been emphasized in earlier studies. In this study, we observed and compared parameters related to binocular vision function in myopic school-age children with and without anisometropia and found differences between groups, indicating that anisometropia impairs binocular vision function. Positive relative accommodation reflects the eye's ability to mobilize and adjust during near vision, while negative relative accommodation reflects the eye's ability to relax. In this study, participants in the myopic anisometropia group showed decreased accommodative amplitude and positive relative accommodation, potentially due to the fact that the myopic eye with higher refraction at near view used less or no accommodation to see clearly because of the closer near point, and at distance, the eye with lower power was used to see the distance. A small positive relative accommodation indicates insufficient, non-durable accommodation. The accommodative facility responds to the speed at which the eye switches focus between near and far objects. Reduced accommodative facility-the eye's diminished ability to swiftly adjust focus between different distances-can lead to blurred vision at both near and far ranges, difficulty maintaining clear vision, and may contribute to the progression of myopia. Individuals with reduced accommodative facility often experience delays when shifting focus between near and distant objects, resulting in transient blurred vision and challenges in sustaining clear vision. Logan et al. found that myopic children exhibited slower accommodative responses compared to their emmetropic peers, indicating a lag in the eye's focusing mechanism [11] . These findings underscore the importance of assessing and managing accommodative function, particularly in individuals at risk for or experiencing myopia, to maintain visual clarity and potentially mitigate progression of myopia. Moreover, while accommodative facility has been previously linked to visual fatigue in general populations [12] , our study establishes this correlation specifically in the control group, suggesting that the interplay between accommodation and fatigue may differ between individuals with and without anisometropia. Reduced accommodative facility requires a buffering period to switch focus, resulting in blurred vision for both near and distant objects, difficulty maintaining clear vision, and an increased risk of myopia progression. To avoid binocular fusion difficulty, a monocular viewing strategy develops, where the eye with higher refractive error is used for near vision, and the eye with lower refractive error is used for distance vision. This reduces visual fatigue symptoms but results in loss of normal binocular single vision. We found that the incidence of binocular vision dysfunction in patients with myopic anisometropia was higher than the control group. These dysfunctions manifest as reduced accommodation amplitude, diminished accommodative facility, and decreased convergence facility. The anisometropic group showed less accommodative facility and convergence facility compared to the control group. In addition, in-depth analysis of the results of the visual function examination revealed that the lack of accommodative facility in the myopic anisometropia group mostly manifested as difficulty in passing through the negative mirror, which could be diagnosed as insufficient accommodation combined with a decrease in binocular accommodative amplitude. When accommodation is insufficient, the eye cannot focus images behind the retina onto the retina itself, creating a state of hyperopic defocus that leads to choroidal thinning and axial lengthening, accelerating myopia progression . In this clinical observation, the total score of the visual fatigue scale in the myopic anisometropia group was higher than that in the control group, and the total score of the visual fatigue scale in both groups was highly negatively correlated with convergence flexibility. Within a certain range (<5%), central fusion can compensate for disparities to achieve binocular single vision. However, if the difference exceeds compensatory ability, it leads to difficulties in binocular fusion. This results in different accommodative demands for the eyes while viewing, requiring constant accommodation and coordination of the ocular muscles. Prolonged tension in these muscles can induce symptoms of visual fatigue, such as eye soreness and pain, impacting the patient's daily life and learning . Visual discomfort constitutes a neurophysiological dysregulation syndrome in which suboptimal visual stimuli induce 3 clinical manifestations: (1) sensory-perceptual abnormalities (photophobia, blurred vision, contrast sensitivity fluctuations), (2) ocular surface dysfunction (tear film instability, accommodative spasm), and (3) neurogenic symptoms (frontal cephalgia, visual motion intolerance). Pathophysiologically, this stems from disrupted accommodative-vergence integration, trigeminovascular activation, and cortical hyperexcitability, with symptom severity correlating with exposure to triggering factors including prolonged near-work (>45 min), high spatial frequency patterns (>3 cycles/degree), or aberrant illumination (≤100 lux or ≥1000 lux). Visual quality is a comprehensive evaluation of optical performance, integrating both subjective perception and objective measurements of optical clarity (visual acuity, contrast sensitivity), focusing dynamics (depth of focus, accommodation accuracy), and neural processing efficiency (glare sensitivity, aberration tolerance). High visual quality means sharp, clear, and comfortable vision across different lighting and focusing conditions, while poor visual quality may result from optical imperfections, higher-order aberrations, or ocular pathology . Patients with myopic anisometropia need optometrists to develop personalized refractive correction. Reasonable optical correction can ameliorate visual discomfort and improve visual quality; it can also reduce the imbalance of accommodative function between the two eyes [13] . The principle of orthokeratological refractive correction is based on nocturnal wearing of a lens with a reverse geometric design to apply precise pressure to the central area of the cornea, while raising the curvature of the cornea in the middle, and thereby temporarily reshaping it [14] . The process is reversible, and the cornea gradually returns to its original state after stopping wearing of the lens, so the effect needs to be maintained at night (the correction amount is about 0.50D~6.00D). Its optical advantage is that the orthokeratology lens does not need to be worn during the day, and the peripheral defocus design may havethe effect of controlling the myopia (evidence level I). The orthokeratology lens accurately regulates the corneal shape of both eyes through an inverse geometric design, and achieves personalized shaping for anisometropia (spherical lens difference ≥1.50D), effectively avoiding the burden of image fusion caused by the unequal frame image (>5%). It acts directly on the optical region of the cornea, eliminating prism effects and aberrations caused by lens thickness differences, significantly improving visual quality and reducing visual fatigue. The fluid mechanics of tears ensures that the correction force is evenly distributed and the correction balance of both eyes is maintained. Peripheral defocus design simultaneously delays ocular axis growth, controls anisometropia progression, and promotes the reconstruction of binocular fusion function by stabilizing naked eye vision, especially in children; it significantly reduces the risk of monocular suppression, and realizes the dual benefits of optical correction and visual function improvement. A longitudinal study showed that the rate of myopia progression in each eye of children with myopic anisometropia was higher than that of the control group [15] . Therefore, for children with myopic anisometropia, orthokeratology is an ideal refractive correction method [16-19] ; it can provide children with good unaided visual acuity and effectively control myopia progression, axial elongation, and anisometropia development [20-22]. Furthermore, it can prevent binocular vision dysfunction and visual fatigue [23] . The eye's accommodative function is crucial to maintain normal vision and visual function and is a prerequisite for clear, comfortable, and long-lasting visual quality [24] . For school-age children with myopic anisometropia, personalized accommodative function training (training improves accommodative lag using Flipper), VR training reshapes visual neural circuits through dichoptic stimulation; 3D vision training enhances stereopsis via disparity tasks. Previous studies have shown that insufficient accommodation, or low accommodative facility not conducive to myopia prevention and control [25] . The strong correlation between visual fatigue and convergence flexibility suggests that specific vision therapy protocols focusing on vergence flexibility may be beneficial for patients with myopic anisometropia. Additionally, given the heightened risk of binocular dysfunction, optometrists should consider early correction strategies and possibly enhanced accommodative or vergence training to mitigate long-term visual discomfort. Most cases of anisometropia are influenced by acquired developmental factors of refractive error, including bad eye behavior habits such as incorrect eye habits and reading postures, which deepen refractive error and increase anisometropia [26-28] . Therefore, for refractive correction of school-age patients with myopic anisometropia, it is necessary to consider the comfort of wearing glasses and the effect of myopia prevention and control; doing a good job in science education to cultivate good eye behavior habits is also very important. In this clinical observation, the binocular vision function of school-age children with myopic anisometropia was innovatively examined, and differences were found between myopic school-age children with anisometropia and those without anisometropia in accommodative function–related parameters, such as accommodative amplitude, accommodative facility, positive relative accommodation, and convergence flexibility, where levels were lower in children with anisometropia compared with those without (control group). Therefore, in the diagnosis and treatment of myopia prevention and control, it is recommended that patients with myopic anisometropia complete the visual fatigue questionnaire to enhance their cognition of visual fatigue. Moreover, doctors should diagnose patients' fatigue and intervene early to reduce the distress caused by visual fatigue in life and study. This will provide new ideas for clinical diagnosis and treatment. Despite strengths, this clinical observation had several limitations. Firstly, the number of participants was small, and patients with high myopic anisometropia were lacking. Secondly, horizontal fusion range, accommodation convergence/accommodation(AC/A) and stereoscopic vision were not measured. Thirdly, because of the limited precision of detection equipment for flexibility of accommodation and selection of gradient and vision standard, the inspection distance was 2.22 times the accommodation near point, and the total inversion lens was 30% of the accommodation amplitude. We will expand the sample size, refine binocular visual function test items, and improve the precision of visual function testing equipment in future work. Methods Inclusion and exclusion criteria Inclusion criteria: Participants were enrolled if they had binocular corrected visual acuity of 1.0 or above and were aged 6–13 years. a. Myopic anisometropia group: Both eyes were myopic (compound myopic anisometropia) or one eye was emmetropic and one eye was myopic (simple myopic anisometropia), with an equivalent spherical diopter >-0.25 DS, and 1.00 DS ≤ the difference in the equivalent spherical power of both eyes -0.25 DS, and interocular difference < 1.00 DS. c.Myopia progresses rapidly,with an annual increase of≥0.75diopters. Exclusion criteria: Participants with ocular surface diseases, strabismus, amblyopia, nystagmus; a history of previous eye trauma; or ophthalmic surgery, as determined through inquiry into clinical symptoms, slit-lamp examination and direct ophthalmoscopy, were excluded. Those who could not cooperate with the examination were also excluded. Participants Before the implementation of the study, the experimenter introduced the purpose, content and all possible consequences of the study to the participants and their parents in detail, and obtained signed informed consent of each subject and their parents. This study complies with the Declaration of Helsinki and was approved by the Ethics Committee of Shenzhen People’s Hospital. This part of the study has completed clinical trial registration. School-aged children (6–13 years old) undergoing medical optometry in the Department of Ophthalmology of Shenzhen People's Hospital from August 2023 to August 2024 were included in this study. After applying the inclusion and exclusion criteria, 100 cases with 200 eyes were enrolled. Using equivalent spherical power (spherical power + 1/2 cylindrical power), participants were divided into a myopic anisometropia group and a control group. The myopic anisometropia group included 50 cases with 100 eyes, of which 23 were boys and 27 were girls, with an average age of 10.40±1.85 years. The control group included 50 cases with 100 eyes, of which 20 were boys and 30 were girls, with an average age of 9.44±1.99 years. All enrolled participants underwent retinoscopy under cycloplegia to determine refraction. According to the participant's refraction results, the corresponding prescription was attached to the automatic phoropter. Visual function examination items included accommodation amplitude (AMP), positive/negative relative accommodation, positive/negative relative accommodation (PRA/NRA), accommodative facility (AF), and convergence facility (CF). Our study utilized Tropicamide and Phenylephrine eye drops (specification: 5 mg tropicamide and 5 mg deoxyadrenaline per ml) as the cycloplegic agent. Participants were placed in a supine position, and eye drops were dropped into the conjunctival sac of their lower eyelid, with 1 drop in each eye. The administration was repeated 3 times, 5 minutes apart. The lacrimal sac area was pressed continuously for 2 minutes after each administration to reduce the risk of systemic absorption. The effect of mydriasis was evaluated 30 minutes after the final dose. When the pupil diameter was ≥6 mm and the light reflex was absent, refractive examination could be performed. Residual accommodation after mydriasis (about 1.00D) may affect accommodative facility tests (such as Flipper tests). Therefore, the evaluation of binocular vision function (e.g. stereoscopic vision, fusion range) was performed 24 hours after mydriasis to ensure data accuracy. Accommodative Amplitude (AMP) The amplitude of accommodation is the difference in refractive power between the distant and near points of fixation, also known as the maximum accommodative force. Based on refractive correction, the modified proximity method was used to measure each eye separately. With one eye occluded, the other was tested using a phoropter. The participant read the smallest line on a near visual acuity chart at 40 cm. The chart was moved closer until letters appeared blurred. The closest distance before blurring was recorded. If the distance was less than 8 cm, a negative lens was added in front of the tested eye, in -0.25D increments, until letters became blurred. The power of the negative lens was recorded, and the accommodative amplitude calculated as 12.50 D plus the added lens power. Each eye was measured three times, and the average value recorded. Positive/negative relative accommodation (PRA/NRA) Near vision (40 cm) charts on the automatic phoropter were used, with full correction of the eyes. The participant was required to fixate on the 20/30 target, and the positive lens was gradually added in front of the participant's eyes in +0.25 D increments until the target began to appear persistently blurred. The maximum positive lens added before blurring occurred was recorded as the NRA value. The PRA measurement process was similar to the NRA measurement process after completion of accommodative response measurement. Again, it was ensured the patient's visual target was clear, and the negative lens was gradually increased in front of the patient's eyes, each time by -0.25 D, until fixation of the optometric target became persistently blurred. The increased negative power was then recorded, representing the PRA value. Accommodative Facility (AF) Based on refractive correction, participants were instructed to fixate on a 20/30 target at 40 cm. Monocular examination was followed by bilateral examination. For monocular examination, one eye was occluded while the other was tested using a ±2.00D flipper. Participants were asked to focus on the target as clearly and quickly as possible. Timing began when the flipper was first flipped, and each time the participant reported the target became clear, the flipper was immediately reversed. This process was repeated until two accommodative stimuli had been completed. The number of cycles completed in 1 minute was recorded as cycles per minute (cpm). Binocular examination was performed in a binocular fixation state, and the measurement and recording method was the same as the monocular method. Results were recorded as: (1) 0 cpm if the participant could not maintain a clear visual target, indicating difficulty with both positive and negative lenses; (2) 0 cpm if the participant could not maintain a clear visual target at +2.00 D, indicating difficulty with positive lenses; and (3) 0 cpm if the participant could not maintain a clear visual target at -2.00 D, indicating difficulty with negative lenses. Convergence facility (CF) After each participant donned fully corrected glasses, they were instructed to focus on a single 20/30 target at 40 cm. In front of either eye, a 3△BI/12△BO prism reversal paddle was placed, and the participant was required to concentrate and transform a blurred or overlapping target into a clear single target as quickly as possible. In this study, participants signaled the researchers when the target became clear, and the prism was immediately replaced. This process was repeated, and the number of cycles completed within 1 minute was recorded (with each completed flip of two prisms counting as one cycle). Ocular examination The corneal reflection and occlusion methods were used to check for ocular position examination and squint. Eye fatigue questionnaire All participants completed the Census version of the Asthenopia Scale Questionnaire (ASQ-11). The questionnaire includes 11 symptom items, categorized into two dimensions: dimension A (ocular symptom dimension, five items) and dimension B (visual function and systemic symptom dimension, six items). According to the severity of symptoms, each item is awarded 0, 1, 2, 3, or 4 points, corresponding to responses of "None", "Mild", "Moderate", "Relatively severe", and "Severe". The total possible score of the questionnaire is 44 points. Statistical methods Frequency (rate) was used to describe categorical variables, while mean ± standard deviation was used for numerical variables obeying the normal distribution. The median (with minimum and maximum values) was used for numerical variables that did not obey the normal distribution. The chi-square test compared categorical variables, while the t-test compared numerical variables obeying a normal distribution. Finally, the Wilcoxon rank-sum test compared numerical variables that did not obey a normal distribution. Correlation of normal data was evaluated using the Pearson correlation coefficient, while the Spearman correlation coefficient was used for skewed data. Declarations Ethics approval and consent to participate Not applicable Consent for publication All the authors approved the manuscript for publication. Availability of Data and Material The original contributions presented in the study are included in the article. Competing interests The authors declare no competing interests. Funding This study was supported by Shenzhen Science and Technology Program (No. JCYJ20220818102603007). Author Contributions Yingpin Cao and Ming-ming Yang designed the study and revised the manuscript. Yingpin Cao and Jiajia Ye wrote and revised the manuscript. Aiqin Nie performed the analysis and wrote the manuscript. Dan Sun revised the manuscript. All the authors reviewed the results and approved the final version of the manuscript. References Y.Zhong, L.Zeng, Z.Chen, J.Yang, and J.Liu. Ocular anatomical and functional characteristics in anisometropic Chinese children. Optometry and Vision Science. 98, 476-482(2021). Y.Y. Hu et al. Prevalence and associations of anisometropia in children. Investigative Ophthalmology & Visual Science . 57, 979-988(2016). S. Wang, Z et al. Two-dimensional, highresolution peripheral refraction in adults with is myopia and anisomyopia. Investigative Ophthalmology & Visual Science. 61, 16-22(2020). T. G. Krarup, I. Nisted, U. Christensen, J. F. Kiilgaard, and M. la Cour. The tolerance of anisometropia. Acta Ophthalmologica. 98, 418-426(2020). Zhuang CC, Zhang L, Pan SS, Wang YN, Guo JX. Accommodation and Binocular Vision in Children with Myopic Anisometropia. J Ophthalmol . 1 ,1-6（2024） Wong CW, Tsai A, Jonas JB. Digital screen time during the COVID-19 pandemic: risk for a further myopia boom? Am J Ophthalmol. 223, 333-337(2021). Yin Hu et al. Rates of Myopia Development in Young Chinese Schoolchildren During the Outbreak of COVID-19. JAMA Ophthalmol. 139, 1115-1121(2021). Horwood AM, Riddell PM. Evidence that convergence rather than accommodation controls intermittent distance exotropia. Acta Ophthalmol. 90 ,109-17（2012） Chen Y, Drobe B, Zhang C et al. Accommodation is unrelated to myopia progression in Chinese myopic children. Sci Rep. 21 ,10(2020) Sheedy, James E, Hayes John et al. Is all Asthenopia the Same? Optometry and Vision Science 80 ,732-739(2003) Logan NS, Radhakrishnan H, Cruickshank FE et al. IMI Accommodation and Binocular Vision in Myopia Development and Progression. Invest Ophthalmol Vis Sci . 62 ,213-218(2021) Y. Song. Accommodation and binocular vision changes after wearing orthokeratology lens in 8-to14-year-old myopic children. Graefes Archive for Clinical and Experimental Ophthalmology. 259, 2035-2045(2021). J. Y. Lee, J. Y. Seo, and S. U. Baek. The effects of glasses for anisometropia on stereopsis. American Journal of Ophthalmology. 156, 1261-1266(2013). Radhakrishnan H,Allen PM,Calver RI. Peripheral refractive changes associated with myopia progression. Invest Ophthalmol Vis Sci , 54, 1573-1581(2013). Lee TT, Cho P. Relative peripheral refraction in children: twelve-month changes in eyes with different ametropias. Ophthalmic Physiol Opt. 33, 283-293(2013). Y. Song, et al. Accommodation and binocular vision changes after wearing orthokeratology lens in 8-to14-year-old myopic children. Graefes Archive for Clinical and Experimental Ophthalmology. 259, 2035-2045(2021). S. H. Lee, M. Kim, H. Kim, and C. Y. Park. Visual fatigue induced by watching virtual reality device and the efect of anisometropia. Ergonomics. 64, 1522-1531(2021). Shen J, Cui H. How ptosis affects the visual quality: an overview of visual quality impairments and contributing factors in ptotic eyes. Int Ophthalmol . 45, 88-92(2025). Nie LL, Ma X, Pei Y. Subjective and objective changes in visual quality after implantable collamer lens implantation for myopia. Front Med . 7 ,12-17(2025) B.H. Altoaimi, P. Kollbaum, D. Meyer, and A. Bradley. Experimental investigation of accommodation in eyes fit with multifocal contact lenses using a clinical auto-refractor. Ophthalmic and Physiological Optics , 38, 152-163(2018). J. Y. Lee, J. Y. Seo, and S. U. Baek. The effects of glasses for anisometropia on stereopsis. American Journal of Ophthalmology. 156, 1261-1266(2013). Y. Song, et al. Accommodation and binocular vision changes after wearing orthokeratology lens in 8-to14-year-old myopic children. Graefes Archive for Clinical and Experimental Ophthalmology. 259, 2035-2045(2021). Ana F Pereira-da-Mota, Jéssica Costa, Ana Amorim-de-Sousa. The Impact of Overnight Orthokeratology on Accommodative Response in Myopic Subjects. J Clin Med. 9, 3687-3693(2020). Martin Ming-Leung Ma,et al. Effect of Vision Therapy on Accommodative Lag in Myopic Children: A Randomized Clinical Trial. Optom Vis Sci. 96, 17-26(2019). T. Satou, M. Ito, Y. Shinomiya, Y. Takahashi, N. Hara, and T. Niida. Diferences in the stimulus accommodative convergence/accommodation ratio using various techniques and accommodative stimuli. Strabismus. 26, 53-61(2018.) D.A. Berntsen, D. O. Mutti, and K. Zadnik. Study of theories about myopia progression (STAMP) design and baseline data. Optometry and Vision Science. 87, 823-832(2010). J.Y. Lee, J. Y. Seo, and S. U. Baek. The efects of glasses for anisometropia on stereopsis. American Journal of Ophthalmology. 156, 1261-1266(2013). B.Golebiowski, J. Long, K. Harrison, A. Lee, N. Chidi-Egboka,and L. Asper. Smartphone use and efects on tear film,blinking and binocular vision. Current Eye Research. 45, 428-434(2020). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 20 May, 2025 Read the published version in Scientific Reports → Version 1 posted Reviewers agreed at journal 14 Apr, 2025 Reviewers invited by journal 13 Apr, 2025 Submission checks completed at journal 09 Apr, 2025 First submitted to journal 07 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6029915","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":442697055,"identity":"148cc8a6-f698-4b24-9360-b0763b6f05ca","order_by":0,"name":"Yingpin Cao","email":"","orcid":"","institution":"ShenZhen People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yingpin","middleName":"","lastName":"Cao","suffix":""},{"id":442697065,"identity":"51916345-293b-4e12-b218-d12c98bbd6f3","order_by":1,"name":"Jiajia Ye","email":"","orcid":"","institution":"ShenZhen People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jiajia","middleName":"","lastName":"Ye","suffix":""},{"id":442697069,"identity":"994f1702-4a1f-42ef-bfa1-5bdfeb8f486a","order_by":2,"name":"Aiqin Nie","email":"","orcid":"","institution":"ShenZhen People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Aiqin","middleName":"","lastName":"Nie","suffix":""},{"id":442697074,"identity":"59dfafcc-263e-4f29-afc8-033c154dec53","order_by":3,"name":"Dan Sun","email":"","orcid":"","institution":"ShenZhen People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Dan","middleName":"","lastName":"Sun","suffix":""},{"id":442697075,"identity":"76b97c7d-adcd-42d0-b87b-339774e012e4","order_by":4,"name":"Ming-ming Yang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAv0lEQVRIiWNgGAWjYDACZiCWqLCR42dmPvyAeC0WZ9KMJdvZ0gyIt6my5XDihvM8ChJEqdZt5z384mYDM+PmwzwMBgw1NtEEtZgd5kuznLmDjdnsMO+BBwzH0nIbCGvhMTOWPMPDBtSbYMDYcJhILX/bJHiMm3kMJIjVYvxAss1AwoCZBC1mDBJnEgwkDgMDOYEov5w/Y/xBouJ/fX//4cMPPtTYENYCBGyI6EggQjkIMH8gUuEoGAWjYBSMVAAANeQ9Eo/0DQMAAAAASUVORK5CYII=","orcid":"","institution":"ShenZhen People’s Hospital","correspondingAuthor":true,"prefix":"","firstName":"Ming-ming","middleName":"","lastName":"Yang","suffix":""}],"badges":[],"createdAt":"2025-02-14 10:53:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6029915/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6029915/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-01309-3","type":"published","date":"2025-05-20T15:57:55+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":83460196,"identity":"d44227f7-9385-497e-aa72-0aaee995ea6a","added_by":"auto","created_at":"2025-05-26 16:11:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1164260,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6029915/v1/f581b9d8-137e-41e9-9f40-828b8f142677.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Correlation Between Binocular Vision Function and Visual Fatigue in School-Age Children With Myopic Anisometropia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAnisometropia refers to a significant difference in refractive power between the two eyes in one or more main meridians\u003csup\u003e\u0026nbsp;[1]\u003c/sup\u003e. Various factors, including genetics, gender, age, environmental factors, education level, and ethnicity, can influence the development of anisometropia\u003csup\u003e\u0026nbsp;[2]\u0026nbsp;\u003c/sup\u003e.\u0026nbsp;Anisometropia exceeding 2.50 D disrupts binocular fusion, impairing the brain's ability to integrate disparate retinal images into a coherent stereoscopic perception. This breakdown in binocularity manifests clinically as diplopia, visual fatigue, and dyslexia-related symptoms, significantly compromising patients' quality of life and cognitive performance\u003csup\u003e\u0026nbsp;[3,4]\u003c/sup\u003e. The pathophysiology involves a hierarchical cascade of neural adaptations: once the interocular refractive difference surpasses fusion thresholds (spherical difference ≥1.50 D or cylindrical\u0026nbsp;≥1.00 D), a consequential retinal image disparity exceeding 5% triggers synaptic plasticity-mediated suppression of the defocused eye's input. At the cellular level, this results in lateral geniculate nucleus (LGN) neuronal atrophy and hypoactivation of primary visual cortex regions V1-V3, establishing contralateral monocular dominance. Chronic cortical inhibition progressively reduces binocular neuron populations from 70% to 30%, while concomitant disruption of superior colliculus-frontal eye field circuitry impairs vergence control.\u0026nbsp;If left untreated,\u0026nbsp;prolonged suppression of the weaker eye can lead to anisometropic amblyopia, with approximately one-third of cases progressing to strabismus due to irreversible reorganization of binocular integration pathways.\u003c/p\u003e\n\u003cp\u003eZhuang et al. previously grouped myopic anisometropia in 8-15 year old children by degree of anisometropia to analyze the\u0026nbsp;accommodative\u0026nbsp;and binocular visual function\u003csup\u003e\u0026nbsp;[\u003c/sup\u003e\u003csup\u003e5\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. This clinical study\u0026nbsp;was more descriptive, but did not delve into the\u0026nbsp;relationship\u0026nbsp;between anisometropia and visual fatigue.\u0026nbsp;In recent years, the prevalence of myopia among school-aged children in China has increased sharply, with an earlier onset and faster progression \u003csup\u003e[6,7].\u003c/sup\u003e Therefore, in this study, we focused on school-age (6-13 years old) children with minimal age variation and rapid myopia progression. The children were grouped into those with myopic isometropia or myopic anisometropia (controls). Each child completed a questionnaire on eye fatigue and also had their binocular vision function measured. This allowed us to not only confirm the impact of anisometropia on binocular visual dysfunction but also establish a clear correlation between binocular vision parameters and visual fatigue. By translating these theoretical findings into clinical practice, our study provides new guidance for individualized management of anisometropia-related asthenopia. Specifically, the strong association between convergence flexibility and visual fatigue suggests that targeted vision therapy and optical interventions may help alleviate symptoms, offering a more precise and symptom-driven approach to managing anisometropia in children\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003ePopulation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 100 eligible participants were enrolled, of whom 50 participants (23 boys, 27 girls) were in the myopic anisometropia group ，the mean age was 9.95\u0026plusmn;1.12 years. No significant difference was found in age or sex among the two groups (all P \u0026gt; 0.05). However, significant differences were found in spherical equivalent refraction (P \u0026lt; 0.05). The demographics of the participants in the two groups are detailed in \u003cstrong\u003eTable 1\u003c/strong\u003e.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"558\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 558px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1. Basic Characteristics of the Myopia Anisometropia Group and the Control Group (\u003cem\u003en\u003c/em\u003e=100)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eThe myopic anisometropia group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003eThe\u0026nbsp;myopic isometropia\u0026nbsp;Group\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender, \u003cem\u003en\u003c/em\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e23(46.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e20(40.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e27(54.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e30(60.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years), \u003cem\u003eMean\u003c/em\u003e\u0026plusmn;\u003cem\u003eSD\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e10.40\u0026plusmn;1.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e9.44\u0026plusmn;1.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight eye Sph, \u003cem\u003eMedian\u003c/em\u003e(\u003cem\u003emin\u003c/em\u003e,\u003cem\u003emax\u003c/em\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e-2.13(-4.50,1.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e-1.25(-4.00,0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight eye Cyl, \u003cem\u003eMedian\u003c/em\u003e(\u003cem\u003emin\u003c/em\u003e,\u003cem\u003emax\u003c/em\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e-0.50(-2.50,0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e-0.25(-1.25,0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft eye Sph, \u003cem\u003eMedian\u003c/em\u003e(\u003cem\u003emin\u003c/em\u003e,\u003cem\u003emax\u003c/em\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e-0.75(-3.50,1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e-1.25(-4.25,0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft eye Cyl, \u003cem\u003eMedian\u003c/em\u003e(\u003cem\u003emin\u003c/em\u003e,\u003cem\u003emax\u003c/em\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e-0.50(-3.00,0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e-0.50(-1.50,0.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSph:Spherical lens; Cyl:Cylinder lens SD:Standard deviation; Min:Minimum; Max:Maximum\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eComparison of the accommodation-related binocular function parameters between groups\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe accommodation-related binocular visual function parameters in both groups did not follow a normal distribution; therefore, the non-parametric Wilcoxon rank sum was performed. The accommodative amplitude (AMP), accommodative facility (AF), and convergence facility (CF) of the myopic anisometropia group were significantly lower than those of the control group. There was no significant difference in negative relative accommodation (NRA) between the two groups (see Table 2).\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eComparison of the results of the ASQ-11 between the two groups\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eThe asthenopia scale questionnaire ASQ-11 scores of the two groups also did not follow a normal distribution so the Wilcoxon rank sum test was conducted. The ASQ-11 score in the anisometropia group was significantly higher than that in the control group (see Table 2).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"561\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 561px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2. Comparison of Accommodative Binocular Visual Function and Eye Fatigue Questionnaire (ASQ-11) Scores between Groups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMyopic Anisometropia Group, Median(min,max)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eThe myopic isometropia Group\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMedian(min,max)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eZ value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003evalue\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAMP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight eye\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e7.00 (2.50, 16.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e12.00 (4.00, 24.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e-4.520\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft eye\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e6.00 (2.50, 14.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e12.00 (2.50, 20.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e-4.735\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight eye\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e2.00 (0.00, 13.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e9.75 (0.50, 15.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e-5.196\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft eye\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e2.75 (0.00, 13.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e9.75 (0.50, 17.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e-5.263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBinocular\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e2.50 (0.00, 13.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e9.00 (0.50, 15.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e-5.178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePRA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e-1.00 (-9.50, 0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e-2.00 (-7.00, 0.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e-2.674\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNRA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e2.50 (0.00, 3.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e2.50 (0.00, 2.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e-1.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e0.309\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e9.75 (2.50, 20.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e12.75 (4.50, 19.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e-3.433\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eASQ-11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e13.00 (5.00, 19.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e6.50 (3.00, 15.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 56px;\"\u003e\n \u003cp\u003e-5.839\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 59px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAMP:Accommodative Amplitude; \u0026nbsp;AF:Accommodative Facility\u003c/p\u003e\n\u003cp\u003ePRA:Positive Relative Accommodation; \u0026nbsp;NRA:Negative Relative Accommodation\u003c/p\u003e\n\u003cp\u003eCF:Convergence Facility; \u0026nbsp;ASQ-11:Asthenopia Scale Questionnaire\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eCorrelation analysis of visual fatigue parameters and accommodation-related binocular visual function parameters\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eSince the visual fatigue parameters and accommodative binocular visual function parameters did not follow a \u0026nbsp;normal distribution, the correlation between these parameters was evaluated by calculating the Spearman correlation coefficient. Coefficients were calculated for the two groups, and the results showed that the scores of the ASQ-11 in both groups were negatively correlated with the convergence flexibility to a medium to high degree (P\u0026lt;0.001). ASQ-11 scores in both the myopic anisometropia group and the control group were significantly negatively correlated with convergence facility. (see Table 3).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"586\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" style=\"width: 586px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 3. Correlation Analysis Between Visual Fatigue Parameters and Accommodative Binocular Vision Parameters\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBinocular Vision Parameters\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMyopic Anisometropia Group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMyopic isometropia Group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpearman Correlation Coefficient\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpearman Correlation Coefficient\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAMP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight eye\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.703\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e-0.234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft eye\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.532\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e-0.190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.187\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRight eye\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e-0.266\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e-0.332\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLeft eye\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e-0.240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e-0.301\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBinocular\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e-0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.800\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e-0.295\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePRA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e-0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.808\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.572\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNRA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e-0.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0.155\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.283\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCF\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 170px;\"\u003e\n \u003cp\u003e-0.785\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e-0.554\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAMP:Accommodative Amplitude;\u0026nbsp;AF:Accommodative Facility\u003c/p\u003e\n\u003cp\u003ePRA:Positive Relative Accommodation;\u0026nbsp;NRA:Negative Relative Accommodation\u003c/p\u003e\n\u003cp\u003eCF:Convergence Facility \u0026nbsp;\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePrevious studies have consistently reported that anisometropia can disrupt binocular vision by impairing fusion, stereopsis, and vergence function. Research by Horwood and Riddell highlighted that anisometropia, particularly in myopic patients, is associated with reduced accommodative accuracy and vergence stability\u003csup\u003e[8]\u003c/sup\u003e. Similarly, Chen et al. found that myopic anisometropia contributes to decreased accommodative amplitude and facility, reinforcing the notion that accommodative control is compromised in these individuals\u003csup\u003e[9]\u003c/sup\u003e. Our study extends these findings by demonstrating that myopic anisometropia can not only reduce accommodative facility but also negatively affect convergence flexibility, which has been less frequently examined in prior research. This underscores the broader impact of myopic anisometropia on dynamic binocular vision function beyond what has been previously documented. Sheedy et al. established that symptoms of asthenopia are frequently associated with vergence instability and reduced accommodative function\u003csup\u003e[10]\u003c/sup\u003e.\u0026nbsp;Zhuang et al. primarily focused on accommodative and binocular vision function in children with myopic anisometropia but did not explore its relationship with visual fatigue. Our study provides new insights by revealing that visual fatigue scores are significantly correlated with convergence flexibility in the myopic anisometropia group (P\u0026lt;0.001), highlighting a specific mechanistic relationship that has not been emphasized in earlier studies.\u003c/p\u003e\n\u003cp\u003eIn this study, we observed and compared parameters related to binocular vision function in myopic school-age children with and without anisometropia and found differences between groups, indicating that anisometropia impairs binocular vision function. Positive relative accommodation reflects the eye\u0026apos;s ability to mobilize and adjust during near vision, while negative relative accommodation reflects the eye\u0026apos;s ability to relax. In this study, participants in the myopic anisometropia group showed decreased accommodative amplitude and positive relative accommodation, potentially due to the fact that the myopic eye with higher refraction at near view used less or no accommodation to see clearly because of the closer near point, and at distance, the eye with lower power was used to see the distance. A small positive relative accommodation indicates insufficient, non-durable accommodation. The accommodative facility responds to the speed at which the eye switches focus between near and far objects. Reduced accommodative facility-the eye\u0026apos;s diminished ability to swiftly adjust focus between different distances-can lead to blurred vision at both near and far ranges, difficulty maintaining clear vision, and may contribute to the progression of myopia. Individuals with reduced accommodative facility often experience delays when shifting focus between near and distant objects, resulting in transient blurred vision and challenges in sustaining clear vision. Logan et al. found that myopic children exhibited slower accommodative responses compared to their emmetropic peers, indicating a lag in the eye\u0026apos;s focusing mechanism\u003csup\u003e[11]\u003c/sup\u003e. These findings underscore the importance of assessing and managing accommodative function, particularly in individuals at risk for or experiencing myopia, to maintain visual clarity and potentially mitigate progression of myopia. Moreover, while accommodative facility has been previously linked to visual fatigue in general populations\u003csup\u003e[12]\u003c/sup\u003e, our study establishes this correlation specifically in the control group, suggesting that the interplay between accommodation and fatigue may differ between individuals with and without anisometropia.\u003c/p\u003e\n\u003cp\u003eReduced accommodative facility requires a buffering period to switch focus, resulting in blurred vision for both near and distant objects, difficulty maintaining clear vision, and an increased risk of myopia progression. To avoid binocular fusion difficulty, a monocular viewing strategy develops, where the eye with higher refractive error is used for near vision, and the eye with lower refractive error is used for distance vision. This reduces visual fatigue symptoms but results in loss of normal binocular single vision. We found that the incidence of binocular vision dysfunction in patients with myopic anisometropia was higher than the control group. These dysfunctions manifest as reduced accommodation amplitude, diminished accommodative facility, and decreased convergence facility.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe anisometropic group showed less accommodative facility and convergence facility compared to the control group. In addition, in-depth analysis of the results of the visual function examination revealed that the lack of accommodative facility in the myopic anisometropia group mostly manifested as difficulty in passing through the negative mirror, which could be diagnosed as insufficient accommodation combined with a decrease in binocular accommodative amplitude. When accommodation is insufficient, the eye cannot focus images behind the retina onto the retina itself, creating a state of hyperopic defocus that leads to choroidal thinning and axial lengthening, accelerating myopia progression\u003csup\u003e\u0026nbsp;\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this clinical observation, the total score of the visual fatigue scale in the myopic anisometropia group was higher than that in the control group, and the total score of the visual fatigue scale in both groups was highly negatively correlated with convergence flexibility. Within a certain range (\u0026lt;5%), central fusion can compensate for disparities to achieve binocular single vision. However, if the difference exceeds compensatory ability, it leads to difficulties in binocular fusion. This results in different accommodative demands for the eyes while viewing, requiring constant accommodation and coordination of the ocular muscles. Prolonged tension in these muscles can induce symptoms of visual fatigue, such as eye soreness and pain, impacting the patient\u0026apos;s daily life and learning\u003csup\u003e.\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVisual discomfort constitutes a neurophysiological dysregulation syndrome\u0026nbsp;in which\u0026nbsp;suboptimal visual stimuli induce\u0026nbsp;3\u0026nbsp;clinical manifestations: (1) sensory-perceptual abnormalities (photophobia, blurred vision, contrast sensitivity fluctuations), (2) ocular surface dysfunction (tear film instability, accommodative spasm), and (3) neurogenic symptoms (frontal cephalgia, visual motion intolerance). Pathophysiologically, this stems from disrupted accommodative-vergence integration, trigeminovascular activation, and cortical hyperexcitability, with symptom severity correlating with exposure to triggering factors including prolonged near-work (\u0026gt;45 min), high spatial frequency patterns (\u0026gt;3 cycles/degree), or aberrant illumination (\u0026le;100 lux or \u0026ge;1000 lux). Visual quality\u0026nbsp;is\u0026nbsp;a comprehensive evaluation of optical performance, integrating both subjective perception and objective measurements of optical clarity (visual acuity, contrast sensitivity), focusing dynamics (depth of focus, accommodation accuracy), and neural processing efficiency (glare sensitivity, aberration tolerance).\u0026nbsp;High visual quality means sharp, clear, and comfortable vision across different lighting and focusing conditions, while poor visual quality may result from optical imperfections, higher-order aberrations, or ocular pathology .\u0026nbsp;Patients with myopic anisometropia need optometrists to develop personalized refractive correction. Reasonable optical correction can ameliorate visual discomfort and improve visual quality; it can also reduce the imbalance of accommodative function between the two eyes \u003csup\u003e[13]\u003c/sup\u003e. The principle of\u0026nbsp;orthokeratological refractive correction is based on nocturnal wearing of a lens with a reverse geometric design to apply precise pressure to the central area of the cornea, while raising the curvature of the cornea in the middle, and thereby temporarily reshaping it\u003csup\u003e[14]\u003c/sup\u003e. The process is reversible, and the cornea gradually returns to its original state after stopping wearing of the lens, so the effect needs to be maintained at night (the correction amount is about 0.50D~6.00D). Its optical advantage is that\u0026nbsp;the\u0026nbsp;orthokeratology lens does not need to be worn during the day, and the peripheral defocus design may havethe effect of controlling the myopia (evidence level I). The orthokeratology lens accurately regulates the corneal shape of both eyes through an inverse geometric design, and achieves personalized shaping for anisometropia (spherical lens difference \u0026ge;1.50D), effectively avoiding the burden of image fusion caused by the unequal frame image (\u0026gt;5%). It acts directly on the optical region of the cornea, eliminating prism effects and aberrations caused by lens thickness differences, significantly improving visual quality and reducing visual fatigue. The fluid mechanics of tears ensures that the correction force is evenly distributed and the correction balance of both eyes is maintained. Peripheral defocus design simultaneously delays ocular axis growth, controls anisometropia progression, and promotes the reconstruction of binocular fusion function by stabilizing naked eye vision, especially in children; it significantly reduces the risk of monocular suppression, and realizes the dual benefits of optical correction and visual function improvement. A longitudinal study showed that the rate of myopia progression in each eye of children with myopic anisometropia was higher than that of the control group\u003csup\u003e[15]\u003c/sup\u003e. Therefore, for children with myopic anisometropia, orthokeratology is an ideal refractive correction method\u003csup\u003e[16-19]\u003c/sup\u003e; it can provide children with good unaided visual acuity and effectively control myopia progression, axial elongation, and anisometropia development \u003csup\u003e[20-22].\u003c/sup\u003e Furthermore, it can prevent binocular vision dysfunction and visual fatigue\u0026nbsp;\u003csup\u003e[23]\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe eye\u0026apos;s accommodative function is crucial to maintain normal vision and visual function and is a prerequisite for clear, comfortable, and long-lasting visual quality\u003csup\u003e\u0026nbsp;[24]\u003c/sup\u003e. For school-age children with myopic anisometropia, personalized accommodative function training (training improves\u0026nbsp;accommodative\u0026nbsp;lag using\u0026nbsp;Flipper),\u0026nbsp;VR training reshapes visual neural circuits through dichoptic stimulation; 3D vision training enhances stereopsis via disparity tasks.\u0026nbsp;Previous studies have shown that\u0026nbsp;insufficient accommodation, or low accommodative facility not conducive to myopia prevention and control \u003csup\u003e[25]\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe strong correlation between visual fatigue and convergence flexibility suggests that specific vision therapy protocols focusing on vergence flexibility may be beneficial for patients with myopic anisometropia. Additionally, given the heightened risk of binocular dysfunction, optometrists should consider early correction strategies and possibly enhanced accommodative or vergence training to mitigate long-term visual discomfort.\u003c/p\u003e\n\u003cp\u003eMost cases of anisometropia are influenced by acquired developmental factors of refractive error, including bad eye behavior habits such as incorrect eye habits and reading postures, which deepen refractive error and increase anisometropia \u003csup\u003e[26-28]\u003c/sup\u003e. Therefore, for refractive correction of school-age patients with myopic anisometropia, it is necessary to consider the comfort of wearing glasses and the effect of myopia prevention and control; doing a good job in science education to cultivate good eye behavior habits is also very important.\u003c/p\u003e\n\u003cp\u003eIn this clinical observation, the binocular vision function of school-age children with myopic anisometropia was innovatively examined, and differences were found between myopic school-age children with anisometropia and those without anisometropia in accommodative function\u0026ndash;related parameters, such as accommodative amplitude, accommodative facility, positive relative accommodation, and convergence flexibility, where levels were lower in children with anisometropia compared with those without (control group). Therefore, in the diagnosis and treatment of myopia prevention and control, it is recommended that patients with myopic anisometropia complete the visual fatigue questionnaire to enhance their cognition of visual fatigue. Moreover, doctors should diagnose patients\u0026apos; fatigue and intervene early to reduce the distress caused by visual fatigue in life and study. This will provide new ideas for clinical diagnosis and treatment.\u003c/p\u003e\n\u003cp\u003eDespite strengths, this clinical observation had several limitations. Firstly, the number of participants was small, and patients with high myopic anisometropia were lacking. Secondly, horizontal fusion range, accommodation convergence/accommodation(AC/A) and stereoscopic vision were not measured. Thirdly, because of the limited precision of detection equipment for flexibility of accommodation and selection of gradient and vision standard, the inspection distance was 2.22 times the accommodation near point, and the total inversion lens was 30% of the accommodation amplitude. We will expand the sample size, refine binocular visual function test items, and improve the precision of visual function testing equipment in future work.\u003c/p\u003e"},{"header":"Methods","content":"\u003ch2\u003e\u003cstrong\u003eInclusion and exclusion criteria\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eInclusion criteria: Participants were enrolled if they had binocular corrected visual acuity of 1.0 or above and were aged 6–13 years.\u003c/p\u003e\n\u003cp\u003ea. Myopic anisometropia group: Both eyes were myopic (compound myopic anisometropia) or one eye was emmetropic and one eye was myopic (simple myopic anisometropia), with an equivalent spherical diopter \u0026gt;-0.25 DS, and 1.00 DS ≤ the difference in the equivalent spherical power of both eyes \u0026lt;2.50 DS.\u003c/p\u003e\n\u003cp\u003eb. Myopic non-anisometropic group (control group): This group had binocular myopia or one eye with emmetropia and one eye with myopia, with an equivalent spherical diopter \u0026gt;-0.25 DS, and\u0026nbsp;interocular difference\u0026nbsp;\u0026lt; 1.00 DS.\u003c/p\u003e\n\u003cp\u003ec.Myopia progresses rapidly,with an annual increase of≥0.75diopters.\u003c/p\u003e\n\u003cp\u003eExclusion criteria: Participants with ocular surface diseases, strabismus, amblyopia, nystagmus; a history of previous eye trauma; or ophthalmic surgery, as determined through inquiry into clinical symptoms, slit-lamp examination and direct ophthalmoscopy, were excluded. Those who could not cooperate with the examination were also excluded.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eBefore the implementation of the study, the experimenter introduced the purpose, content and all possible consequences of the study to the participants and their parents in detail, and obtained signed informed consent of each subject and their parents. This study complies with the Declaration of Helsinki and was approved by the Ethics Committee of Shenzhen People’s Hospital. This part of the study has completed clinical trial registration.\u003c/p\u003e\n\u003cp\u003eSchool-aged children (6–13 years old) undergoing medical optometry in the Department of Ophthalmology of Shenzhen People's Hospital from August 2023 to August 2024 were included in this study. After applying the inclusion and exclusion criteria, 100 cases with 200 eyes were enrolled. Using equivalent spherical power (spherical power + 1/2 cylindrical power), participants were divided into a myopic anisometropia group and a control group. The myopic anisometropia group included 50 cases with 100 eyes, of which 23 were boys and 27 were girls, with an average age of 10.40±1.85 years. The control group included 50 cases with 100 eyes, of which 20 were boys and 30 were girls, with an average age of 9.44±1.99 years.\u003c/p\u003e\n\u003cp\u003eAll enrolled participants underwent retinoscopy under cycloplegia to determine refraction. According to the participant's refraction results, the corresponding prescription was attached to the automatic phoropter. Visual function examination items included accommodation amplitude (AMP), positive/negative relative accommodation, positive/negative relative accommodation (PRA/NRA), accommodative facility (AF), and convergence facility (CF).\u003c/p\u003e\n\u003cp\u003eOur study\u0026nbsp;utilized\u0026nbsp;Tropicamide and Phenylephrine\u0026nbsp;eye drops\u0026nbsp;(specification: 5 mg tropicamide and 5 mg deoxyadrenaline per ml)\u0026nbsp;as the\u0026nbsp;cycloplegic agent. Participants were placed in a supine position, and eye drops were dropped into the conjunctival sac of their lower eyelid, with 1 drop in each eye. The administration was repeated 3 times, 5 minutes apart. The lacrimal sac area was pressed continuously for 2 minutes after each administration to reduce the risk of systemic absorption. The effect of mydriasis was evaluated 30 minutes after the final dose. When the pupil diameter was\u0026nbsp;≥6 mm and the light reflex was absent, refractive examination could be performed. Residual accommodation after mydriasis (about 1.00D) may affect accommodative facility tests (such as Flipper tests). Therefore, the evaluation of binocular vision function (e.g. stereoscopic vision, fusion range) was performed 24 hours after mydriasis to ensure data accuracy.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eAccommodative Amplitude (AMP)\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe amplitude of accommodation is the difference in refractive power between the distant and near points of fixation, also known as the maximum accommodative force.\u0026nbsp;Based on refractive correction, the modified proximity method was used to measure each eye separately. With one eye occluded, the other was tested using a phoropter. The participant read the smallest line on a near visual acuity chart at 40 cm. The chart was moved closer until letters appeared blurred. The closest distance before blurring was recorded. If the distance was less than 8 cm, a negative lens was added in front of the tested eye, in -0.25D increments, until letters became blurred. The power of the negative lens was recorded, and the accommodative amplitude calculated as 12.50 D plus the added lens power. Each eye was measured three times, and the average value recorded.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003ePositive/negative relative accommodation (PRA/NRA)\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eNear vision (40 cm) charts on the automatic phoropter were used, with full correction of the eyes. The participant was required to fixate on the 20/30 target, and the positive lens was gradually added in front of the participant's eyes in +0.25 D increments until the target began to appear persistently blurred. The maximum positive lens added before blurring occurred was recorded as the NRA value. The PRA measurement process was similar to the NRA measurement process after completion of accommodative response measurement. Again, it was ensured the patient's visual target was clear, and the negative lens was gradually increased in front of the patient's eyes, each time by -0.25 D, until fixation of the optometric target became persistently blurred. The increased negative power was then recorded, representing the PRA value.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eAccommodative Facility (AF)\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eBased on refractive correction, participants were instructed to fixate on a 20/30 target at 40 cm. Monocular examination was followed by bilateral examination. For monocular examination, one eye was occluded while the other was tested using a ±2.00D flipper. Participants were asked to focus on the target as clearly and quickly as possible. Timing began when the flipper was first flipped, and each time the participant reported the target became clear, the flipper was immediately reversed. This process was repeated until two accommodative stimuli had been completed. The number of cycles completed in 1 minute was recorded as cycles per minute (cpm). Binocular examination was performed in a binocular fixation state, and the measurement and recording method was the same as the monocular method. Results were recorded as: (1) 0 cpm if the participant could not maintain a clear visual target, indicating difficulty with both positive and negative lenses; (2) 0 cpm if the participant could not maintain a clear visual target at +2.00 D, indicating difficulty with positive lenses; and (3) 0 cpm if the participant could not maintain a clear visual target at -2.00 D, indicating difficulty with negative lenses.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eConvergence facility (CF)\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eAfter each participant donned fully corrected glasses, they were instructed to focus on a single 20/30 target at 40 cm. In front of either eye, a 3△BI/12△BO prism reversal paddle was placed, and the participant was required to concentrate and transform a blurred or overlapping target into a clear single target as quickly as possible. In this study, participants signaled the researchers when the target became clear, and the prism was immediately replaced. This process was repeated, and the number of cycles completed within 1 minute was recorded (with each completed flip of two prisms counting as one cycle).\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eOcular examination\u0026nbsp;\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eThe corneal reflection and occlusion methods were used to check for ocular position examination and squint.\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eEye fatigue questionnaire\u0026nbsp;\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eAll participants completed the Census version of the Asthenopia Scale Questionnaire (ASQ-11). The questionnaire includes 11 symptom items, categorized into two dimensions: dimension A (ocular symptom dimension, five items) and dimension B (visual function and systemic symptom dimension, six items). According to the severity of symptoms, each item is awarded 0, 1, 2, 3, or 4 points, corresponding to responses of \"None\", \"Mild\", \"Moderate\", \"Relatively severe\", and \"Severe\". The total possible score of the questionnaire is 44 points.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eStatistical methods\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eFrequency (rate) was used to describe categorical variables, while mean ± standard deviation was used for numerical variables obeying the normal distribution. The median (with minimum and maximum values) was used for numerical variables that did not obey the normal distribution. The chi-square test compared categorical variables, while the t-test compared numerical variables obeying a normal distribution. Finally, the\u0026nbsp;Wilcoxon\u0026nbsp;rank-sum test compared numerical variables that did not obey a normal distribution. Correlation of normal data was evaluated using the Pearson correlation coefficient, while the Spearman correlation coefficient was used for skewed data.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors approved the manuscript for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe original contributions presented in the study are included in the article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by Shenzhen Science and Technology Program (No. JCYJ20220818102603007).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYingpin Cao and Ming-ming Yang designed the study and revised the manuscript. Yingpin Cao and Jiajia Ye wrote and revised the manuscript. Aiqin Nie performed the analysis and wrote the manuscript. Dan Sun revised the manuscript. All the authors reviewed the results and approved the final version of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eY.Zhong, L.Zeng, Z.Chen, J.Yang, and J.Liu. Ocular anatomical and functional characteristics in anisometropic Chinese children. \u003cem\u003eOptometry and Vision Science.\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e98,\u0026nbsp;\u003c/strong\u003e476-482(2021).\u003c/li\u003e\n \u003cli\u003eY.Y. Hu et al. Prevalence and associations of anisometropia in children. \u003cem\u003eInvestigative Ophthalmology \u0026amp; Visual Science\u003c/em\u003e. \u003cstrong\u003e57,\u003c/strong\u003e 979-988(2016).\u003c/li\u003e\n \u003cli\u003eS. Wang, Z et al. Two-dimensional, highresolution peripheral refraction in adults with is myopia and anisomyopia. \u003cem\u003eInvestigative Ophthalmology \u0026amp; Visual Science.\u003c/em\u003e\u003cstrong\u003e61,\u003c/strong\u003e16-22(2020).\u003c/li\u003e\n \u003cli\u003eT. G. Krarup, I. Nisted, U. Christensen, J. F. Kiilgaard, and M. la Cour. The tolerance of anisometropia. \u003cem\u003eActa Ophthalmologica.\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e98,\u0026nbsp;\u003c/strong\u003e418-426(2020).\u003c/li\u003e\n \u003cli\u003eZhuang CC, Zhang L, Pan SS, Wang YN, Guo JX. Accommodation and Binocular Vision in Children with Myopic Anisometropia.\u003cem\u003e\u0026nbsp;J Ophthalmol\u003c/em\u003e. \u003cstrong\u003e1\u003c/strong\u003e,1-6（2024）\u003c/li\u003e\n \u003cli\u003eWong CW, Tsai A, Jonas JB. Digital screen time during the COVID-19 pandemic: risk for a further myopia boom? \u003cem\u003eAm J Ophthalmol.\u003c/em\u003e\u003cstrong\u003e223,\u0026nbsp;\u003c/strong\u003e333-337(2021).\u003c/li\u003e\n \u003cli\u003eYin Hu et al. Rates of Myopia Development in Young Chinese Schoolchildren During the Outbreak of COVID-19. \u003cem\u003eJAMA Ophthalmol.\u003c/em\u003e\u003cstrong\u003e139,\u0026nbsp;\u003c/strong\u003e1115-1121(2021).\u003c/li\u003e\n \u003cli\u003eHorwood AM, Riddell PM. Evidence that convergence rather than accommodation controls intermittent distance exotropia. \u003cem\u003eActa Ophthalmol.\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e90\u003c/strong\u003e,109-17（2012）\u003c/li\u003e\n \u003cli\u003eChen Y, Drobe B, Zhang C et al. Accommodation is unrelated to myopia progression in Chinese myopic children. \u003cem\u003eSci Rep.\u003c/em\u003e\u003cstrong\u003e21\u003c/strong\u003e,10(2020)\u003c/li\u003e\n \u003cli\u003eSheedy, James E, Hayes John et al. Is all Asthenopia the Same? \u003cem\u003eOptometry and Vision Science\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e80\u003c/strong\u003e,732-739(2003)\u003c/li\u003e\n \u003cli\u003eLogan NS, Radhakrishnan H, Cruickshank FE et al. IMI Accommodation and Binocular Vision in Myopia Development and Progression.\u003cem\u003eInvest Ophthalmol Vis Sci\u003c/em\u003e.\u003cstrong\u003e62\u003c/strong\u003e,213-218(2021)\u003c/li\u003e\n \u003cli\u003eY. Song. Accommodation and binocular vision changes after wearing orthokeratology lens in 8-to14-year-old myopic children. \u003cem\u003eGraefes Archive for Clinical and Experimental Ophthalmology.\u003c/em\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e259,\u0026nbsp;\u003c/strong\u003e2035-2045(2021).\u003c/li\u003e\n \u003cli\u003eJ. Y. Lee, J. Y. Seo, and S. U. Baek. The effects of glasses for anisometropia on stereopsis. \u003cem\u003eAmerican Journal of Ophthalmology.\u003c/em\u003e\u003cstrong\u003e156,\u003c/strong\u003e1261-1266(2013).\u003c/li\u003e\n \u003cli\u003eRadhakrishnan H,Allen PM,Calver RI. Peripheral refractive changes associated with myopia progression. \u003cem\u003eInvest Ophthalmol Vis Sci\u003c/em\u003e,\u003cstrong\u003e54,\u003c/strong\u003e1573-1581(2013).\u003c/li\u003e\n \u003cli\u003eLee TT, Cho P. Relative peripheral refraction in children: twelve-month changes in eyes with different ametropias. \u003cem\u003eOphthalmic Physiol Opt.\u003c/em\u003e\u003cstrong\u003e33,\u003c/strong\u003e283-293(2013).\u003c/li\u003e\n \u003cli\u003eY. Song, et al. Accommodation and binocular vision changes after wearing orthokeratology lens in 8-to14-year-old myopic children. \u003cem\u003eGraefes Archive for Clinical and Experimental Ophthalmology.\u003c/em\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e259,\u0026nbsp;\u003c/strong\u003e2035-2045(2021).\u003c/li\u003e\n \u003cli\u003eS. H. Lee, M. Kim, H. Kim, and C. Y. Park. Visual fatigue induced by watching virtual reality device and the efect of anisometropia. \u003cem\u003eErgonomics.\u003c/em\u003e\u003cstrong\u003e64,\u0026nbsp;\u003c/strong\u003e1522-1531(2021).\u003c/li\u003e\n \u003cli\u003eShen J, Cui H. How ptosis affects the visual quality: an overview of visual quality impairments and contributing factors in ptotic eyes. \u003cem\u003eInt Ophthalmol\u003c/em\u003e.\u003cstrong\u003e45,\u003c/strong\u003e88-92(2025).\u003c/li\u003e\n \u003cli\u003eNie LL, Ma X, Pei Y. Subjective and objective changes in visual quality after implantable collamer lens implantation for myopia. \u003cem\u003eFront Med\u003c/em\u003e.\u003cstrong\u003e7\u003c/strong\u003e,12-17(2025)\u003c/li\u003e\n \u003cli\u003eB.H. Altoaimi, P. Kollbaum, D. Meyer, and A. Bradley. Experimental investigation of accommodation in eyes fit with multifocal contact lenses using a clinical auto-refractor. \u003cem\u003eOphthalmic and Physiological Optics\u003c/em\u003e,\u003cstrong\u003e38,\u003c/strong\u003e 152-163(2018).\u003c/li\u003e\n \u003cli\u003eJ. Y. Lee, J. Y. Seo, and S. U. Baek. The effects of glasses for anisometropia on stereopsis. \u003cem\u003eAmerican Journal of Ophthalmology.\u003c/em\u003e\u003cstrong\u003e156,\u003c/strong\u003e1261-1266(2013).\u003c/li\u003e\n \u003cli\u003eY. Song, et al. Accommodation and binocular vision changes after wearing orthokeratology lens in 8-to14-year-old myopic children. \u003cem\u003eGraefes Archive for Clinical and Experimental Ophthalmology.\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e259,\u003c/strong\u003e 2035-2045(2021).\u003c/li\u003e\n \u003cli\u003eAna F Pereira-da-Mota, J\u0026eacute;ssica Costa, Ana Amorim-de-Sousa. The Impact of Overnight Orthokeratology on Accommodative Response in Myopic Subjects. \u003cem\u003eJ Clin Med.\u003c/em\u003e\u003cstrong\u003e9,\u003c/strong\u003e3687-3693(2020).\u003c/li\u003e\n \u003cli\u003eMartin Ming-Leung Ma,et al. Effect of Vision Therapy on Accommodative Lag in Myopic Children: A Randomized Clinical Trial. \u003cem\u003eOptom Vis Sci.\u003c/em\u003e\u003cstrong\u003e96,\u003c/strong\u003e17-26(2019).\u003c/li\u003e\n \u003cli\u003eT. Satou, M. Ito, Y. Shinomiya, Y. Takahashi, N. Hara, and T. Niida. Diferences in the stimulus accommodative convergence/accommodation ratio using various techniques and accommodative stimuli.\u003cem\u003eStrabismus.\u003c/em\u003e\u003cstrong\u003e26,\u003c/strong\u003e 53-61(2018.)\u003c/li\u003e\n \u003cli\u003eD.A. Berntsen, D. O. Mutti, and K. Zadnik. Study of theories about myopia progression (STAMP) design and baseline data. \u003cem\u003eOptometry and Vision Science.\u003c/em\u003e\u003cstrong\u003e87,\u003c/strong\u003e 823-832(2010).\u003c/li\u003e\n \u003cli\u003eJ.Y. Lee, J. Y. Seo, and S. U. Baek. The efects of glasses for anisometropia on stereopsis. \u003cem\u003eAmerican Journal of Ophthalmology.\u003c/em\u003e\u003cstrong\u003e156,\u0026nbsp;\u003c/strong\u003e1261-1266(2013).\u003c/li\u003e\n \u003cli\u003eB.Golebiowski, J. Long, K. Harrison, A. Lee, N. Chidi-Egboka,and L. Asper. Smartphone use and efects on tear film,blinking and binocular vision. \u003cem\u003eCurrent Eye Research.\u003c/em\u003e\u003cstrong\u003e45,\u003c/strong\u003e428-434(2020).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"anisometropia, visual function, myopia, eye fatigue","lastPublishedDoi":"10.21203/rs.3.rs-6029915/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6029915/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"This study investigated differences in binocular vision and visual fatigue between school-aged children with myopic anisometropia and myopic isometropia. It also examined the correlation between myopic anisometropia and binocular vision parameters. One hundred school-aged (ages 6-13 years) children (43 boys and 57 girls) were divided into two groups: the myopic anisometropia group (interocular spherical equivalent difference ≥1.50 D and \u003c4.00 D) and the myopic isometropia group as control group (interocular spherical equivalent difference \u003c1.00 D). Binocular vision parameters related to accommodation were analyzed, including accommodative amplitude, flexibility, relative accommodation, and convergence flexibility. Differences in visual fatigue scores between groups were also evaluated. The myopic anisometropia group had significantly lower accommodative amplitude, flexibility, and convergence flexibility compared to the control group. Visual fatigue scores were higher in the myopic anisometropia group, and scores were negatively correlated with convergence flexibility (P\u003c0.001). Additionally, fatigue scores were negatively correlated with accommodative facility in the control group. There is a correlation between the change in binocular vision function parameters and myopic anisometropia. Moreover, the combination of myopia and anisometropia has a compounding effect, making binocular vision dysfunction and visual fatigue more likely to occur compared to myopia without anisometropia.","manuscriptTitle":"Correlation Between Binocular Vision Function and Visual Fatigue in School-Age Children With Myopic Anisometropia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-15 15:08:28","doi":"10.21203/rs.3.rs-6029915/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"299120647509576280338650876507364457261","date":"2025-04-14T05:49:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-14T00:04:08+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-09T06:49:50+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-04-07T13:36:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d1232c04-d10e-46c0-ac97-70a6def8f935","owner":[],"postedDate":"April 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":47128382,"name":"Health sciences/Health care"},{"id":47128383,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2025-05-26T16:06:39+00:00","versionOfRecord":{"articleIdentity":"rs-6029915","link":"https://doi.org/10.1038/s41598-025-01309-3","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-05-20 15:57:55","publishedOnDateReadable":"May 20th, 2025"},"versionCreatedAt":"2025-04-15 15:08:28","video":"","vorDoi":"10.1038/s41598-025-01309-3","vorDoiUrl":"https://doi.org/10.1038/s41598-025-01309-3","workflowStages":[]},"version":"v1","identity":"rs-6029915","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6029915","identity":"rs-6029915","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}