Combined Accommodation and Fusional Training Paradigm Versus Prism Correction for Small-Angle Acute Acquired Comitant Esotropia: A Cohort Study
- 1Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University
Abstract
Introduction This study explored 6-month ocular alignment and visual function outcomes associated with a combined accommodative and fusional training paradigm and compared them with outcomes observed after prism correction in patients with small-angle acute acquired comitant esotropia. Methods This prospective, single-center, nonrandomized cohort study enrolled 42 patients with small-angle acute acquired comitant esotropia. Following counseling regarding both treatment options, patients selected visual training (N = 22) or prism correction (N = 20). The training group completed a 6-month, two-step paradigm: accommodative facility training using ± 2.00 diopter flippers and computer-based fusional divergence training with red-blue glasses. The prism group received prism correction to relieve diplopia. Examinations were performed at baseline, 1 week, 1 month, 3 months, and 6 months. Results At 6 months, the training group achieved complete motor success (orthophoria without diplopia) in 16/22 (72.7%) at distance and 17/22 (77.3%) at near, compared with 0/20 at either fixation distance in the prism group. Functional success, defined as an ocular deviation of ≤ 5 PD at both distance and near without diplopia, was achieved in 20/22 (90.9%) of the training group versus 0/20 (0.0%) of the prism group. All patients in the prism group reported relief of diplopia during prism wear but persistent diplopia when assessed without prism correction. The training group also showed more favorable changes in several stereopsis and accommodative measures. Conclusions In this small nonrandomized cohort, preference-based selection of combined visual training was associated with more favorable 6-month outcomes than prism correction when outcomes were assessed without prism correction. These exploratory findings are hypothesis-generating and require confirmation in adequately powered randomized studies. Trial Registration ClinicalTrials.gov identifier, NCT06622044.
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BibTeX
@article{guo2026combined,
title = {{Combined Accommodation and Fusional Training Paradigm Versus Prism Correction for Small-Angle Acute Acquired Comitant Esotropia: A Cohort Study}},
author = {Shuyang Guo and Ling Ling and Ziqing Ding and Jingrong Liu and Yan Liu and Rui Liu and Zhi Chen and Chen Zhao and Sida Xi and Wen Wen},
journal = {Ophthalmology and Therapy},
year = {2026},
month = oct,
doi = {10.1007/s40123-026-01507-w},
url = {https://doi.org/10.1007/s40123-026-01507-w},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Combined Accommodation and Fusional Training Paradigm Versus Prism Correction for Small-Angle Acute Acquired Comitant Esotropia: A Cohort Study
AU - Shuyang Guo
AU - Ling Ling
AU - Ziqing Ding
AU - Jingrong Liu
AU - Yan Liu
AU - Rui Liu
AU - Zhi Chen
AU - Chen Zhao
AU - Sida Xi
AU - Wen Wen
PY - 2026
DA - 2026/10/25
JO - Ophthalmology and Therapy
DO - 10.1007/s40123-026-01507-w
UR - https://doi.org/10.1007/s40123-026-01507-w
AB - Introduction This study explored 6-month ocular alignment and visual function outcomes associated with a combined accommodative and fusional training paradigm and compared them with outcomes observed after prism correction in patients with small-angle acute acquired comitant esotropia. Methods This prospective, single-center, nonrandomized cohort study enrolled 42 patients with small-angle acute acquired comitant esotropia. Following counseling regarding both treatment options, patients selected visual training (N = 22) or prism correction (N = 20). The training group completed a 6-month, two-step paradigm: accommodative facility training using ± 2.00 diopter flippers and computer-based fusional divergence training with red-blue glasses. The prism group received prism correction to relieve diplopia. Examinations were performed at baseline, 1 week, 1 month, 3 months, and 6 months. Results At 6 months, the training group achieved complete motor success (orthophoria without diplopia) in 16/22 (72.7%) at distance and 17/22 (77.3%) at near, compared with 0/20 at either fixation distance in the prism group. Functional success, defined as an ocular deviation of ≤ 5 PD at both distance and near without diplopia, was achieved in 20/22 (90.9%) of the training group versus 0/20 (0.0%) of the prism group. All patients in the prism group reported relief of diplopia during prism wear but persistent diplopia when assessed without prism correction. The training group also showed more favorable changes in several stereopsis and accommodative measures. Conclusions In this small nonrandomized cohort, preference-based selection of combined visual training was associated with more favorable 6-month outcomes than prism correction when outcomes were assessed without prism correction. These exploratory findings are hypothesis-generating and require confirmation in adequately powered randomized studies. Trial Registration ClinicalTrials.gov identifier, NCT06622044.
SN - 2193-8245
SN - 2193-6528
ER -