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Purpose : To compare the effect of combinational office-based and home-based orthoptic training regimens with part-time patching in participants with intermittent exotropia. Methods : In a randomized clinical trial study, patients with a diagnosis of IXT were involved and randomly assigned to three groups. Patients in the control group were followed with part-time patch therapy. For the Intervention 1 group, in-office and home-based orthoptic training was prescribed along with playing with a video game software (PIVOT). For Intervention 2 group the same management protocol was incorporated except using the video game software. Evaluation of the control scale and degree of deviation, accommodation, convergence, and stereopsis was performed at baseline and at 1.5 months, 3 months, and 6 months follow-ups. Results : A total of 53 patients (21 males and 32 females) with a mean age of 10.15 ± 3.80 years (range 5-18 years) completed the treatment and follow-up visits. The angle of deviation at distance decreased significantly in all groups ( p < .05). No significant reduction of near angle of deviations was found in the control group ( p = .38). In the intervention groups, positive fusional vergence (PFV), stereopsis, near point of convergence (NPC), and control scale of deviation at distance improved significantly compared to the control group (all, p < .05). At six months follow-up, patients in the Int 1. group showed significantly increased amplitude of accommodation and positive relative accommodation (PRA) compared to the patients in the Int 2. and control groups (all, p < .05). Conclusion : Compared to part-time patch therapy, orthoptic training is more effective in the management of children with IXT. Using video games as a home-based therapy can improve accommodative abilities in these patients.

Prcis: We used anterior segment optical coherence tomography to investigate anterior chamber angle in primary angle-closure glaucoma (PACG) eyes following phacoemulsification and phacotrabeculectomy. Angle widening was significantly greater after phacoemulsification up to 6 months after the surgery., Purpose: To compare anterior chamber angle following 2 common surgeries for PACG., Methods: One hundred ten glaucoma patients were evaluated in this single center, prospective, randomized clinical trial. Those with concomitant PACG and senile cataract and without a history of ocular surgery, trauma, or chronic miotic use were recruited. Monocular patients were also excluded. Finally, 52 eligible subjects were randomly assigned to phacoemulsification ("Phaco" group, 25 eyes) or phacotrabeculectomy ("Combined" group, 27 eyes) surgeries. A swept-source, anterior segment optical coherence tomography device (CASIA SS-1000 OCT) was used to image the anterior segment. Mask graders used the images to measure the following parameters before and 1 week, 1 month, and 6 months after surgery: angle opening distance at 500 µm, trabecular iris surface area at 500 µm, and trabecular iris angle at 500 µm., Results: There was no significant difference between study groups regarding best-corrected visual acuity, intraocular pressure (IOP), and the number of glaucoma medications in preoperative or postoperative visits (P>0.076). Also, the measured angle parameters were not statistically significantly different between the 2 groups before surgery (P>0.123). After surgery, all measured parameters were significantly increased in both groups (P<0.0001). At the 6-month follow-up, nasal angle opening distance at 500 µm was 0.383±0.027 vs. 0.349±0.017, trabecular iris surface area at 500 µm was 0.141±0.007 vs. 0.125±0.005, and trabecular iris angle at 500 µm was 40.1±12.9 vs. 34.6±3.1 in Phaco and Combined groups, respectively (P<0.0001 for all)., Conclusions: Anterior chamber angle widening by anterior segment optical coherence tomography was observed in PACG patients following surgery and was significantly greater after phacoemulsification compared with combined phacotrabeculectomy at all time points. Similar IOP and medication burden were noted for up to 6 months as secondary outcomes. The contribution of angle changes to the IOP-lowering effect of phacoemulsification in PACG eyes needs further study., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Clinical Relevance: Frequent clinical application of cycloplegia in clinical practice makes it essential to assess how this condition influences anterior segment angle parameters., Background: This study aims to compare the effects of cyclopentolate and tropicamide on anterior segment angle parameters in three adult refractive groups., Methods: Sixty healthy individuals were recruited and assigned into three refractive groups according to inclusion criteria. At baseline visit, anterior segment angle parameters were measured using anterior segment optical coherence tomography in the right eye. All measurements were repeated at two separate visits, one week apart, after administration of tropicamide 1% and cyclopentolate 1% at similar conditions. Main outcome measures were angle-opening distance, trabecular iris angle, trabecular iris space area and anterior chamber depth. Anterior segment angle parameters were recorded at temporal areas (180 degrees)., Results: Sixty participants (29 men and 31 women, age: 27.82 ± 4.71-years) completed the experiment. Baseline mean spherical equivalents were +1.52 ± 1.20 D, -0.04 ± 0.33 D and -1.91 ± 0.91-D in hyperopic, emmetropic and myopic groups, respectively. No statistically significant differences were found between tropicamide and cyclopentolate for all angle parameters in three refractive groups. Both drops induced an increase in all parameters in three refractive groups. Analysis between refractive groups revealed that a more hyperopic refraction was associated with less trabecular iris angle, angle-opening distance and anterior chamber depth parameters in baseline, after tropicamide and cyclopentolate instillations., Conclusions: Topical application of cycloplegic eye drops in healthy individuals leads to small but significant changes in anterior chamber depth and anterior segment angle parameters, regardless of refractive status. Moreover, lower values of anterior chamber depth and anterior segment angle parameters in hyperopic individuals after administration of cycloplegic drops should be taken into account during biometric measurement and phakic intraocular lens implantation. Due to shorter effect and recovery time and less ocular/systemic reaction of tropicamide versus cyclopentolate, tropicamide could be a recommended cycloplegic agent for diagnostic and therapeutic procedures.

Purpose: To study binocular and accommodative characteristics and their associations with age and gender in an Iranian young adult population., Methods: In this cross-sectional study, multistage cluster sampling was done from the students of Mashhad University of Medical Sciences. All participants had visual acuity, refraction, and cover tests followed by measurements of the near point of convergence (NPC), amplitude of accommodation (AA), monocular and binocular accommodative facility (MAF and BAF) using ±2.00 diopter (D) flipper lenses, and negative and positive relative accommodation (NRA and PRA). Near and distance fusional vergence reserves were measured using prism bar, and near associated phoria was assessed using the Mallett unit., Results: The mean age of the participants was 22.5±4.4 years (range: 18-35 years). The binocular and accommodative characteristics and their means in the studied sample included: mean distance dissociated phoria: 1.15 exophoria±2.04 prism diopters (PD), near dissociated phoria: 5.02 exophoria±4.74 PD, near associated phoria: 0.55 base-in±1.02, gradient accommodative convergence/accommodation (AC/A) ratio: 4.66±1.59, NPC: 5.27±3.60 cm, MAF: 11.33±5.58 cpm, BAF: 8.84±4.47 cpm, NRA: 2.08±0.33 D, PRA:-2.92±0.76 D, and AA: 11.14±2.6 D. In the multiple regression model including age and gender, near exophoria was significantly higher in men and levels of near base-out-break and near base-out-recovery were higher in females. Distance exophoria, distance base-in-break, distance base-in-recovery, and NPC increased with age and near base-out-break, PRA, BAF, MAF, and AA significantly decreased with age., Conclusion: Studied indices in this study significantly differ from available guidelines and these differences must be considered when making diagnostic or therapeutic decisions. Certain indices can be affected by age and gender.

Purpose: To determine the distribution of negative relative accommodation (NRA) and positive relative accommodation (PRA) and its relationship with binocular vision indices in a young population., Methods: In this cross-sectional study conducted in a student population, samples were selected through multistage cluster sampling. All the samples underwent the measurement of uncorrected and corrected visual acuity and refraction. Then far and near cover tests were performed. The near point of convergence (NPC) and accommodation, accommodation facility, PRA and NRA were evaluated in all participants., Results: The mean age of the 382 participants was 22.5 ± 4.4 years (18-35 years). Mean NRA and PRA in the total sample was +2.08 ± 0.33 diopter (D) and -2.92 ± 0.76 D, respectively. Mean NRA was highest in hyperopic ( P  = 0.002) and mean PRA was highest in myopic ( P  = 0.003) participants. The multiple model showed that NRA had a direct relationship with accommodation facility and spherical refractive error, while PRA had a direct relationship with amplitude of accommodation (AA)., Conclusion: This study provides the normal range of the NRA and PRA and their relationship with accommodation facility, spherical refractive error, and AA in a sample of the Iranian population.