This study demonstrates the safety and efficacy of EMAA in the rehabilitation of vergence disorders, combining the use of virtual reality (VR) and eye tracking.
Abstract
Background
Vergence disorders are generally treated by office-based vergence/accommodative therapy. Novel technologies now make it possible to include patients in their own care and increase efficiency. Eye movement ability analysis (EMAA) is a software designed to treat binocular vision disorders, combining the use of virtual reality (VR) and eye tracking. The objective of this study is to evaluate, in routine practice and in real-life settings, the safety and efficacy of EMAA in the rehabilitation of vergence disorders.
Methods
Retrospectively, the elements of an orthoptic assessment (fusional vergences, near point of convergence [NPC], heterophoria, stereoacuity) performed by French orthoptists in their routine practice, were evaluated before and after rehabilitation by EMAA. Symptoms, adverse effects, compliance and use of telecare were also recorded.
Results
After vision therapy, 80% of participants had improved near positive fusional vergence by at least 10 prism diopters. More generally, fusional vergence (near positive: P<0.001; near negative: P=0.014), NPC (P<0.001) and symptoms improved (after rehabilitation, 94% were headache-free, 95% asthenopia-free and 96% eye pain-free). Seventy-two percent of patients completed their follow-up. Seventeen percent of rehabilitation sessions were carried out using telecare. No serious adverse events and very few non-serious adverse events (3%) were reported.
Conclusion
This study demonstrates the safety and efficacy of EMAA.
Luminopia demonstrated significant improvements in Registry patients with severe amblyopia, particularly in treatment-naive patients, supporting its use as a viable treatment option that may address key limitations of traditional approaches.
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CLINICAL RELEVANCE
Vergence assessment is a fundamental component of binocular vision evaluation, enabling clinicians to detect and monitor conditions such as convergence insufficiency. Accurate and repeatable clinical tests are essential for reliable diagnosis and for tracking patient progress over time.
BACKGROUND
The Near Point of Fixation Disparity (NPFD), associated positive fusional vergence (APFV) range, and associated negative fusional vergence (ANFV) range are polarised Nonius-based tests designed to evaluate vergence system integrity. However, their repeatability remains uninvestigated, limiting clinical utility. This study is the first to assess intraexaminer and interexaminer repeatability of these tests in symptomatic and asymptomatic participants. The NPFD test is commercially available from Vision Assessment Corporation, Rolling Meadows, IL, USA.
METHODS
This prospective, cross-sectional study enrolled 64 university students (32 symptomatic, 32 asymptomatic; aged 18-27 years) from King Saud University, Riyadh, Saudi Arabia. Symptom status was classified using the Convergence Insufficiency Symptom Survey (CISS; score ≥21 = symptomatic). Two trained optometrists performed all measurements across two sessions separated by two weeks. Repeatability was assessed using mean difference, 95% confidence intervals, intraclass correlation coefficient, coefficient of repeatability, and Bland-Altman analysis.
RESULTS
Intraexaminer repeatability of the NPFD test ranged from moderate to good with intraclass correlation coefficient 0.47-0.86, with the strongest agreement observed in asymptomatic participants. The APFV and ANFV ranges demonstrated poor intraexaminer repeatability, with limits of agreement frequently exceeding 10-15 prism dioptres. Interexaminer repeatability was poor across all three tests in both groups, with negative intraclass correlation coefficient values in several comparisons and limits of agreement exceeding 20 prism dioptres.
CONCLUSION
Although the NPFD test can achieve acceptable intraexaminer repeatability, its interexaminer reliability remains poor, raising concerns about its use as a diagnostic tool across different examiners. Vergence assessments should be performed by the same examiner, and changes of less than 10-15 prism dioptres should be interpreted with caution. Standardisation of testing protocols is strongly recommended to improve the clinical applicability of these tests.
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SMILE with micro-monovision had an impact on accommodative function in the early postoperative stage in myopic patients with presbyopia, and patients exhibited good distance and near vision, maintained binocular visual functions, and reported high subjective satisfaction.
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FS-LASIK combined with monovision is an effective treatment for patients aged over 40y with myopia and presbyopia, which not only improves visual acuity but also achieves high patient satisfaction and improves postoperative BCC.
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The onset of visual fatigue caused by the conflict between vergence and accommodation in stereoscopic augmented reality systems is a factor that necessitates limiting the duration of use of this technology. This study investigates the potential to reduce visual fatigue through exercises targeting vergence and accommodation after the use of augmented reality glasses. A survey was conducted to assess momentary visual fatigue and its subsequent change, involving male and female participants aged 20–25 years, without ophthalmological conditions and without the need for vision correction. The study was based on direct work with augmented reality glasses, and the results indicate that eye fatigue reported immediately after use can be reduced in some participants when specific ophthalmological exercises are performed. From a practical perspective, the obtained results outline the exercises as an easily accessible tool for maintaining visual hygiene, enhancing visual comfort, and improving the conditions for the use of Augmented Reality for professional, educational, and recreational purposes.