Abstract / Summary
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. 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. 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. 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. ClinicalTrials.gov identifier, NCT06622044.