Eyes exercises influence on refractive error, and reserves of accomodation and convergention

Abstract

Rasa Ciumbaraite¹, Olga Sergejeva¹, Gaile Mazeikaite¹, Mantas Banevicius¹, Rasa Liutkeviciene²³

¹ Lithuanian University of Health Sciences, Lithuania

²Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, Lithuania

³Neuroscience Institute, Lithuanian University of Health Sciences, Lithuania

rasaciumbaraite@yahoo.com

Introduction. Accommodation (from Latin accomodatio = adaptation) is the eye ability to adapt for clear vision at various distances. It is provided for by coordinated operation of three elements: the ciliary muscle, the Zinn's zonule and the crystalline lens. The normal state for the eye is the far accommodation, then muscles are relaxed. To watch an item near, the ciliary muscle is contracted while the Zinn's zunules are relaxed, this results in the crystalline lens increases its circumflexion (becomes more convex). This increases the optic power by 12-13 diopter, the light rays are focused within retina and the image is clear. Without an accommodation stimulus the ciliary muscle gets relaxed, the refraction power is decreased and the eye is focused to infinite distance again and that is desaccommodation or the far-accommodation [1].Spasm of accommodation is a condition which refers to prolonged contraction of the ciliary musclecaused by insufficient opportunity to relax and then sudden increase of myopia.

The aim of our research was to determine the eye exercises influence on visual acuity, reserves of accommodation and convergence.

Methods.Having obtained permission from the Kaunas Regional Biomedical Research Ethics Committee, the study was conduscted in the Department of Ophthalmology at Lithuanian University of Health Sciences. Fifteenchildrenfrom 9 to 18 years  were investigated at the momentary research. All the patients had myopia or pseudomyopia. All children wereassigned for eye exercises for two weeks duration (10 days).

We used the following subject inclusion criteria: (i) patients of both genders; (ii) age 9 to 18 years; (iii) patients with myopia; (iv) patients with pseudomyopia; (v) participation consent.

Subject exclusion criteria: (i) children until 9 years old age; (ii) children older 18 years old; (iii) patients with other refractive errors; (iv) patients with other eye disorders.

In this research, visual acuity as well as the transparency of the cornea and lens, and the fundus were investigated in the patients. Biomicroscopy was performed in order to assess the corneal and lenticular transparency. Non-corrected and the best-corrected visual acuity (measured in decimals from 0.1 to 1.0) was evaluated using Landolt’s rings (C optotypes) by Snellen test types at a 5 meter distance from the chart. Autorefractometry, monocular reserves of accomadation and convergention were evaluated before and after eye exercises.

Reserves of accommodation(AR) were evaluated with miopic skiaskopy bar, ranging from sph (-1.00 to -19.00 D)for each eye separately from 5 meters. Refractive error before evaluating AR must be corrected. Patient is looking with one eye through the first step (-1.0D), until he/she reaches the maximumal dioptric power which allows the eye to accommodate, ant see 1.0. Convergence reserves (CR) is determined for each eye separately from 5 meterswithout the accommodation. CR is determined binocular: before one eye placed red glass and against the other eye- prism (basis temporal). The patient sees 2 lights- red and white. When the image merge- close their eyes and open their eyes again until the merge time isn’t equa l.0 (immediately merge). After that strengthening the prism add 2.0-4.0 prism D and again reaches the image merge, until we found the strongest prism, which overcomes the additional fusion convergence. The training of CR is carried by the same method.

Statistical analysis was performed using the computer program SPSS/W 22.0 (Social sciences statistical package program for Windows, Inc., Chicago, Illinois, USA). c2 test was used for comparing frequencies of qualitative variables. Statistically significant difference was considered if p<0.05.

Results. A total of 15 children (30 eyes) were examined; 11 (73.3%) were boys and 4 (26.7%) were girls. Visual acuity before eye exercises was 0.34±0.31, after exercises was 0.39±0.36. AR before eye exercises was 6.40±3.72, after exercises was 11.43±3.60.CR before eye exercises was 20.07±8.04, after exercises was 29.77±6.23. Correction before eye exercises was -1.98±1.84, after exercises was -1.98±1.98 (p>0.05) (Table 1).

Table 1.

Before Exercises (±SD)

After Exercises

(±SD)

P value

Visual acuity

0.34 (0.31)

0.39 (0.36)

p>0.05

Accommodation reserves

6.40 (3.72)

11.43 (3.60)

p>0.05

Convergence reserves

20.07 (8.04)

29.77 (6.23)

p>0.05

Correction

-1.98 (1.84)

-1.98 (1.98)

p>0.05

Visual acuity difference before and after eye exercises was 0.05± 0.14.AR difference before and after eye exercises was 5.03± 3.54.CR difference before and after eye exercises was 9.70± 8.43. Correction difference before and after eye exercises was 00.0± 0.36 (p>0.05) (Table 2).

Table 2. Difference before and after eye exercises

Different (±SD)

P value

Visual acuity

0.05 (0.14)

p>0.05

Accommodation reserves

5.03 (3.54)

p>0.05

Convergence reserves

9.70 (8.43)

p>0.05

Correction

0.00 (0.36)

p>0.05

Discussion.Our results revealed,that visual acuity, AR, CR before eye exercises were worse comparing with the results after eye exercises but there were difference was not statistical significant. There are no many studies analyzing eye exercises influence on myopia development. Others studies analyzed treatment for myopia: optical correction, pharmaceutical treatment like cycloplegic promoters, vision therapy, orthokeratology, refractive surgeries (radial keratotomy, excimer laser photorefractive keratectomy), osteopathy, yoga therapy and aerobic exercise therapy [2]. The available treatment option for myopia have many consequences like cosmetic problems, eye strain, asthenopic symptoms, post LASIK infection, postoperative infection, recurrence of refractive error etc. to overcome from these consequences the eye exercise can provide beneficial therapeutic effect for the treatment or prevention of the development of myopia without any consequences. Limitation of this review is lack of systemic review and lack of clinical trials [3].Eye exercises can improve a large group of terms including vergence problems, ocular motility disorders, accommodative dysfunction, amblyopia, learning disabilities, dyslexia, asthenopia, myopia, motion sickness, sports performance, stereopsis, visual field defects, visual acuity, and general well-being[4].

Our results revealed, that visual acuity, AR and CR were better, but further research is required.

Conlusions. Visual acuity, accommodation reserves and convergence reserves was increased after eye exercises.

References

1. http://en.excimerclinic.ru/press/myopiafalse
2. Verhoeven VJ, Wong KT, Buitendijk GH, Hofman A, Vingerling JR, Klaver CC.Visual consequences of refractive errors in the general population. Ophthalmology 2015; 122: 101-9.
3. Rahul Pandey, Vencita Priyanka Aranha, Asir John Samuel, Senthil P. Kumar. A Scoping Literature Review on Effects of Eye Exercises for Myopia in Children. Physiotherapy and Occupational Therapy Journal 27 Volume 8 Number 1, January - March 2015
4. Rawstron JA, Burley CD, Elder MJ.A systematic review of the applicability and efficacy of eye exercises.

J PediatrOphthalmol Strabismus. 2005 Mar-Apr;42(2):82-8.

Eyes exercises influence on refractive error, and reserves of accomodation and convergention

Rasa Ciumbaraite¹, Olga Sergejeva¹, Gaile Mazeikaite¹, Mantas Banevicius¹, Rasa Liutkeviciene²³

¹ Lithuanian University of Health Sciences, Lithuania

²Department of Ophthalmology, Medical Academy, Lithuanian University of Health Sciences, Lithuania

³Neuroscience Institute, Lithuanian University of Health Sciences, Lithuania

rasaciumbaraite@yahoo.com

The aim of this research was to determine the eye exercises influence visual acuity, accommodation reserves and convergence reserves.

Methods.We examined 15of 9-18 year-old children. All the patients had myopia or pseudomyopia. All children wereassigned for eye exercises for two weeks duration.

Results.. Visual acuity before eye exercises was 0.34±0.31, after exercises was 0.39±0.36. AR before eye exercises was 6.40±3.72, after exercises was 11.43±3.60.CR before eye exercises was 20.07±8.04, after exercises was 29.77±6.23. Correction before eye exercises was -1.98±1.84, after exercises was -1.98±1.98 (p>0.05). Visual acuity difference before and after eye exercises was 0.05± 0.14.AR difference before and after eye exercises was 5.03± 3.54.CR difference before and after eye exercises was 9.70± 8.43. Correction difference before and after eye exercises was 00.0± 0.36 (p>0.05).

Conlusion.Visual acuity, accommodation reserves and convergence reserves was increased after eye exercises.