Influence of a long-distance optical imaging workbench on accommodation and choroidal response in myopic children

Clinical relevance: Optical approaches to modulating near work may be beneficial in arresting the progression of myopia Background: To explore whether a long-distance optical image workbench (LOIW) can replace traditional near-distance reading and has beneficial influences on accommodation and choroidal parameters. Methods: This self-control study included two sessions. In session 1, an open-field autorefractor measured sustained accommodative response and pupil diameter when participants viewed virtual images from 3.42 m away through LOIW with + 0.50 D over-correction lenses (3.42 m/+0.50 D), LOIW with full-correction lenses (3.42 m/FC), or the visual target at a given distance of 0.33 m with + 0.50 D over-correction lenses (0.33 m/+0.50 D), with full-correction lenses (0.33 m/FC). In session 2, swept-source optical coherence tomography angiography assessed subfoveal choroidal thickness (SFChT), choroidal volume (CV), and choriocapillaris flow void percentage (FV%) at baseline and before and after reading via LOIW with + 0.50 D over-correction lenses (Far/+0.50 D) or in habitual near distance with full-correction (Near/FC) for a sustained 30-min period. Results: Thirty-five myopic (mean spherical equivalent refraction: −1.11 ± 0.78 D) children (median [range] age: 8.36 [8–10] years) were analysed. Children viewing virtual images in 3.42 m/+0.50 D exhibited mild-degree accommodative leads (−0.54 ± 0.17 D), much smaller pupil diameter (3.39 ± 0.63 mm) and microfluctuations (0.13 ± 0.04 D); accommodative lags (0.88 ± 0.04 D), larger pupil diameter (5.05 ± 0.75 mm) and microfluctuations (0.88 ± 0.16 D) were observed in 0.33 m/+0.50 D, and the microfluctuations were unstable (F = 2.185, p = 0.038). Compared with baseline data, SFChT, CV, and FV% changed by 13.40 ± 4.71 μm, 0.26 ± 0.21 mm³, and − 0.14%±3.66% in Far/+0.50 D, respectively, while changes under Near/FC were − 10.19 ± 7.48 μm, −0.15 ± 0.22 mm³ and 1.95%±2.92%, respectively. All changes differed significantly between these two conditions (all p < 0.001). Conclusion: The long-distance working mode may exert beneficial effects on accommodative and choroidal parameters in myopic children compared with traditional near work.