Efficacy of naked-eye 3D technology in mitigating myopia progression among children

Introduction

Myopia is recognized as the leading cause of visual impairment globally, with projections estimating that approximately half of the world may be affected by 2050 (1). The prevention and control of myopia present particularly pressing challenges among adolescents in China, due to the increasing prevalence of myopia and the earlier age of onset (2,3). Early-onset myopia is associated with more rapid progression and an increased risk of developing high myopia. Consequently, enhancements in the field of myopia prevention and control are advancing rapidly (4,5). Prevailing theories of myopia prevention primarily include the visual defocus and scleral hypoxia hypotheses, which underpin the effectiveness of various intervention measures, such as orthokeratology lenses, peripheral defocus lenses, and atropine eye drops, aiming at slowing myopia progression (6-8). However, these methods are not without limitations, as adverse drug reactions and corneal health risks associated with orthokeratology lenses present ongoing concerns. Thus, the exploration of safer, non-invasive strategies for myopia prevention remains critical.

Several studies have indicated that accommodative lag, which results from prolonged near work, may be one of the causes of axial elongation of the eye. Restoring accommodative function through vision training may be beneficial for controlling myopia progression (9,10). Additionally, deficits in binocular vision caused by reduced accommodative function may also contribute to the progression of myopia. Research by Poudel et al. has found that changes in the On-Off pathways in the visual cortex, which process light and dark vision, may be associated with myopia progression. Based on their existing theories, they hypothesized that reactivating the On pathway could slow down the progression of myopia (11). In our team’s previous study, we quantified and measured the binocular imbalance values in 1,000 children with myopia and found that binocular imbalance is widely prevalent among children with myopia. The dominant eye in binocular imbalance may bear a heavier load of visual processing tasks, which could lead to a faster increase in myopic refractive error during myopia progression (12).

Currently, research on the relationship between binocular vision and myopia progression remains at the theoretical stage, with a lack of clinical practice. With the gradual development of display technologies, virtual reality (VR) has increasingly come into focus. Presently, VR technology has been applied in the recovery and evaluation of binocular vision following strabismus surgery, as well as in assessing binocular visual function (13,14). Compared to traditional methods of measuring binocular vision, the VR platform is capable of precisely quantifying dynamic stereopsis and binocular imbalance in patients (12). This study is based on the VR platform to measure binocular vision in patients and employs naked-eye 3D technology to conduct visual training. The aim is to observe whether naked-eye 3D technology can restore impaired binocular vision and its effectiveness in controlling myopia progression. We present this article in accordance with the TREND reporting checklist (available at https://tp.amegroups.com/article/view/10.21037/tp-2024-523/rc).

Methods

Study participants

Adolescents with low myopia who visited Shenzhen Eye Hospital were recruited for this study from April 5, 2023 to June 1, 2024.

Inclusion criteria were as follows: (I) age range of 6–12 years; (II) a spherical equivalent (SE) between 0 and −1.50 diopters (D) as determined by cycloplegic refraction; (III) full understanding of the purpose of the study by both participants and their guardians, with the ability to cooperate with treatment and related examinations.

Exclusion criteria were as follows: (I) astigmatism exceeding 1.50 D; (II) best-corrected visual acuity below 1.0, or a previous diagnosis of amblyopia; (III) strabismus greater than 5 prism diopters (PD); (IV) anisometropia over 1.50 D; (V) current or prior participation in any myopia control treatment.

Examination and intervention methods

Biometric examination methods

• General ophthalmic examination: each participant underwent a comprehensive ocular anterior segment examination using a slit lamp biomicroscope (Topcon SL-2G, Japan). Eye position was assessed using a medical flashlight in conjunction with refractive targets. Assessments of ocular motility and alternate cover test with a prism were performed. Following cycloplegic refraction, the ocular fundus was examined using a handheld direct ophthalmoscope (WelchAllyn-12851, USA).
• Cycloplegic refraction: compound tropicamide eye drops (Shenyang Xingqi Pharmaceutical Co., Ltd., China) were administered in three applications at 10-minute intervals. Following a 20-minute waiting period to ensure adequate ciliary muscle paralysis in both eyes, retinoscopy was performed with a YZ6E retinoscope (66 Vision-Tech Co., Ltd., Suzhou). Best-corrected visual acuity, SE, and cylindrical power were recorded.
• Axial length (AL) measurement: axial length data were obtained using an IOL (intraocular lens) Master 700.

Visual perceptual function measurement

Visual perceptual examination

A binocular visual perceptual examination was conducted using a specialized visual perception system. The examination setup included a Windows XP PC host, an LG2342p polarized 3D display with a resolution of 1,920×1,080 and a refresh rate of 120Hz. A visual perceptual examination assessment system (Hunan Aoshi Medical Technology Co., Ltd.) was used, with stimulus templates generated using Matlab software. Participants were positioned 80 cm from the display, with their eyes aligned at the screen’s midpoint, and polarized glasses were worn throughout the assessment. Indicators measured included binocular contrast balance at levels of 50 and 200, visual acuity measured with the tumbling E chart (E-target test) at distances of 0.8 meters (E0.8m) and 1.5 meters (E1.5m), and stereoscopic perception evaluated with striped patterns.

Binocular contrast balance

Participants, equipped with binocular vision glasses, observed the test interface depicted in Figure 1A. When viewing with the right eye, participants were presented with a grayscale image defined by the equation y = sin(x) over x = [pi/2, 2pi], while viewing with the left eye displayed y = sin(x) over x = [0, 3pi/2]. The initial contrast balance for both eyes was set to 100%. Adjustments were made based on participant feedback: if the white area appeared larger, the contrast on the right side was reduced using a decrement button; if the black area appeared larger, the contrast on the left side was similarly reduced. Adjustments were made in 5% increments until the participant reported equal areas of black and white. The recorded contrast values for both eyes were used to calculate the binocular imbalance index, defined as the contrast value of the right eye minus that of the left eye. A positive index indicated left-eye dominance, while a negative index indicated right-eye dominance, with smaller absolute values reflecting reduced binocular imbalance. Contrast balance was evaluated under two stimulus sizes1deg * 1deg (contrast balance 50) and 4deg * 4deg (contrast balance 200).

Figure 1 Schematic diagram of visual perceptual test indexes. (A) Schematic diagram of the contrast balance test interface; (B) schematic diagram of the striped stereopsis test interface.

Detection of visual acuity based on the tumbling E chart

The stimulus parameters for the visual acuity assessment included a gray background with luminance of 44 cd/m² and a visual angle of 38°×18°. Target size was set to 0.8°×0.8°, with an average luminance for white and black at 80 candela/m² (cd/m²) and 30 cd/m². The test was conducted at a distance of 0.8 m for near vision and 1.5 m for far vision.

Examination method

Each participant in the test was equipped with polarized glasses to observe the stimulus image displayed on a screen, at testing distances of 80 cm and 1.5 m. In this configuration, the right eye viewed an inverted ⌟, while the left eye viewed ﾻ. Participants were instructed to identify whether they perceived⌟, inverted ﾻ, or inverted ∃, and responses were recorded accordingly.

A grading system was established to classify and analyze the visual status of participants based on the E-target test outcomes:

• Grade 0: This grade represents optimal visual performance, where participants perceive only the ∃ symbol. This observation indicates a robust binocular fusion function without any foveal suppression.
• Grade 1: Assigned when participants report seeing ∃, ⌟, or ㅋ, Grade 1 indicates binocular fusion function accompanied by intermittent, alternating foveal suppression. This reflects a relatively balanced visual state between both eyes.
• Grade 2: Defined by participants perceiving a combination of ∃ and ㅋ or ∃ and ⌟, Grade 2 signifies binocular fusion function with intermittent monocular foveal suppression. In this case, one eye exhibits dominance, reflecting a degree of binocular imbalance.
• Grade 3: Characterized by the perception of only ⌟ or ㅋ, Grade 3 reflects a lack of binocular fusion function. This outcome indicates alternating foveal suppression and poor fixation stability.
• Grade 4: This grade is assigned when participants perceive only ⌟ or ㅋ, signifying an absence of binocular fusion function and constant monocular foveal suppression.

Stereoscopic measurement with striped patterns

Stimulus parameters: the stimulus display featured a grayscale background with a luminance of 44 cd/m², presenting a black-and-white striped pattern with an average luminance of 36 cd/m² within a circular field of 10° in diameter. The primary stimulus consisted of a moving bird (7°×3°), depicted through frames of moving black-and-white stripes overlaid with static bird images. The spatial frequencies of the striped patterns corresponded to progressive grades as follows: 4, 3.4, 2.9, 2.5, 2, 1.8, 1.7, 1.5, 1.4, and 1.3 cycles per degree (deg/cpd). The stripes moved at a constant rate of 52 pixels per second, with a relative disparity of 800 arcseconds between the upper and lower images of the bird.

Participants, wearing polarized binocular glasses, observed these moving graphics and identified which of the two images (upper or lower) appeared closer. A correct response triggered a decrease in the spatial frequency of the stripes, a reduction in the movement speed of the bird, and a corresponding increase in difficulty. The highest grade reached by the participant was recorded, with grade 10 as the maximum grade (Figure 1B).

Measurement of accommodation flexibility

Accommodation flexibility was assessed by an experienced optometrist using a ±2.00 D flip lens placed in front of the participants’ eyes. Participants were instructed to focus on a near target positioned 40 cm away. Once the target appeared clear, the lens was promptly flipped to −2.00 D. The number of complete accommodation cycles within one minute was recorded separately for the right eye, left eye, and both eyes.

Intervention methods

Following discussions, parents voluntarily selected one of the following myopia control methods: 0.01% atropine eye drops, visual perceptual training, or deferred treatment. In the 0.01% atropine group, one drop of 0.01% atropine was administered once nightly before bedtime. In the visual perceptual training group, visual perceptual function and accommodation flexibility measurements were completed at baseline and after a three-month follow-up period. Participants in this group engaged in two daily visual perceptual training sessions, each lasting 10 minutes, with a minimum 5-minute interval between sessions. Training was conducted on a light-field, naked-eye 3D display tablet (Shenzhen Yinglun Technology Ltd.), using a training model provided by Hunan Aoshi Medical Technology Co., Ltd. Training data were transmitted to the study coordinator via internet connection. Only days in which both training sessions were completed were recorded as effective training days. The study coordinator issued reminders to parents every Wednesday and Sunday to enhance compliance.

Visual perceptual training program

The visual perceptual training program consisted of two components. The first is visual perceptual adaptation training, which was used to identify the dominant and non-dominant eyes based on contrast balance values. In this component, contrast was adjusted so that the non-dominant eye (depicted as the right eye in Figure 2A) undergoes targeted visual perceptual contrast balance training. This process involved decreasing contrast for the dominant eye while increasing contrast for the non-dominant eye, to activate the brain-based pathways associated with visual perception and processing, thereby preparing participants for the subsequent phase of training.

Figure 2 Schematic diagram of visual perceptual training programs. (A) Schematic diagram of the visual perceptual adaptation training; (B) schematic diagram for virtual accommodation training.

The second component, virtual accommodation training, utilizes naked-eye 3D technology to generate objects with distinct depth layers, simulating real-world visual accommodation scenarios. Within this virtual environment, participants engaged in both dynamic and static accommodation tasks. During the dynamic task, participants were instructed to continuously adjust their focus to track virtual objects that move across varying depths. This task is designed to enhance the flexibility and endurance of the eye’s accommodation response. In the static task, participants focused on stationary objects positioned at various depths. This task aims to improve the accuracy and stability of the accommodation mechanism when fixating on objects at fixed distances (Figure 2B).

Statistical analysis

Statistical analyses were conducted using R software (version 4.2.2). The correlation coefficient between the SE and axial length for both left and right eyes was assessed through the Pearson correlation coefficient. The analysis revealed no significant correlation between the SEs of the left and right eyes across the three groups. However, a strong correlation was noted for axial lengths (r=0.91–0.97). As a result, SE and AL data from the left and right eyes in each group were analyzed independently. To ensure balanced probability, the entropy rebalancing technique was applied to generate appropriate weights, without designating a reference group. Following rebalancing, the standardized mean difference (SMD) of all covariates was less than 0.1. No statistically significant differences were found in the baseline SE and axial length between the left and right eyes across groups after weighting. Subsequently, correlation analyses on the SE and axial length were performed across the three groups before and after three months. Statistical significance was set at a P value of less than 0.05 (P<0.05). The one-sample t-test was used to analyze changes in accommodation flexibility in the visual perceptual training group before and after 3 months.

Ethical statement

This study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments and was approved by the Ethics Committee of Shenzhen Eye Hospital (No. 2022KYPJ059). Written informed consent was obtained from the minor(s)’ legal guardian for the publication of any potentially identifiable images or data included in this article. It was also registered on the Chinese Clinical Trial Registration Center (http://www.chictr.org/), with the registration number ChiCTR2100045457.

Results

A total of 110 participants were initially enrolled in the study, with 48 assigned to the visual perceptual training group, 32 to the 0.01% atropine group, and 30 to the control group. Participants in the visual perceptual training group who completed fewer than four training sessions per week, as well as participants in any group with follow-up delayed by more than 1 week beyond the expected time, were excluded from the statistical analysis. Ultimately, 81 participants met the criteria for final analysis, consisting of 37 males (45.68%) and 44 females (54.32%). Among them, 28 were from the visual perceptual training group (15 did not meet the required training frequency, and five were excluded due to delayed follow-up), 30 were from the low-concentration atropine group (2 discontinued atropine due to photophobia and were excluded), and 23 were from the control group (5 had delayed follow-up, and 2 received additional myopia control measures, resulting in their exclusion) (Figure 3).

Figure 3 Flowchart of the enrollment process of study participants.

Changes in SE and axial length of both eyes in the three groups

Baseline characteristics of the three groups are presented in Table 1, while data on myopia progression over 3 months are detailed in Table 2. The entropy rebalancing technique was used to generate a series of appropriate weights, aiming to achieve the highest probability of balance without designating any group as a reference group (15). After weighting, the SMD for all covariates was <0.1. Following weighting, myopia progression in the right eye for each group is detailed in Figure 4A, while progression in the left eye is depicted in Figure 4B. Significant differences in SE were observed between the visual perceptual training group and the control group for both eyes, with a 0.386 D difference in SE progression in the right eye (P<0.001) and a 0.24 D difference in the left eye (P=0.03). No statistically significant differences in SE were noted between the 0.01% atropine group and the control group in either eye.

Figure 4 Changes in spherical equivalent of both eyes before and after 3 months. (A) Changes in the spherical equivalent of the right eye in the three groups following weighting. (B) Changes in the spherical equivalent of the left eye in three groups following weighting. D, diopter; OD, oculus dexter (right eye); OS, oculus sinister (left eye); SE, spherical equivalent refraction.

Changes in flexibility of accommodation and visual perceptual function in the visual perceptual training group

At baseline, flexibility of accommodation was measured at 6.44±3.94 cycles per minute (cpm) in the right eye, 7.19±3.41 cpm in the left eye, and 4.54±3.58 cpm binocularly. After a 3-month follow-up, an increase of 2.5 cpm was observed in the right eye (95% CI, 1.318–3.682, P<0.001), a 1.75 cpm increase in the left eye (95% CI, 0.580–2.920, P=0.006), and a 2.279 cpm increase in binocular flexibility of accommodation (95% CI, 0.807–3.755, P=0.005).

Status of visual perceptual function indicators before and after training

Table 3 presents the status of visual perceptual function indicators before and after training. The mean ± standard deviation (SD) for changes in contrast balance at 50 was −6.62±12.19 (P=0.002), and at 200 was −7.70±14.32 (P=0.003). For visual acuity measured by the tumbling E chart, the E0.8m was −0.24±0.68 (P=0.042) and E1.5m was −1.00±1.45 (P<0.001). The mean ± SD of changes in stereoscopic measurements with striped patterns was 0.97±1.48 (P=0.001).

No adverse events were reported throughout the study. By the conclusion of the study, both the visual perceptual training group and the 0.01% atropine group achieved a best-corrected visual acuity of 1.0 or better.

Discussion

With advancements in display technology, naked-eye 3D technology has become an innovative tool in vision therapy, drawing considerable attention for its impact on binocular vision and its potential for myopia prevention and control. In particular, this technology is used to train accommodative function by simulating real-world depth perception, much like traditional “pencil pushup” exercises. The objective is to enhance accommodative ability as a means of myopia prevention and management.

A randomized clinical trial by Xie and Zhao demonstrated that naked-eye 3D training over 6 months slowed myopia progression and effectively controlled axial elongation in both eyes (16).

Subgroup analyses indicated a more pronounced impact on the children with myopia levels below 3.0 D. Supporting these findings, research by Huang et al. revealed that naked-eye 3D training enhanced binocular accommodative flexibility, though improvement was less marked in children with high myopia compared to those with low to moderate myopia (17). However, both studies omitted evaluations of stereopsis changes post-training.

In the present study, naked-eye 3D training incorporated a visual perceptual training module, targeting not only accommodative function but also the restoration of impaired binocular vision. Results revealed a significant deceleration in the progression rate of the SE in both eyes among participants in the visual perceptual training group. Additionally, improvements in the flexibility of accommodation and brain-based visual indicators were observed. However, no significant differences in axial length control were noted among the three groups, aligning with the axial length trends at the three-month follow-up in the studies conducted by Xie and Zhao. Extended follow-up may yield more significant findings regarding axial length changes.

Binocular vision encompasses a broad array of visual functions, with current mainstream research primarily centered on binocular integration, binocular rivalry, and stereopsis (18). Findings from the study conducted by Jiang and Meng indicate that binocular integration and rivalry jointly contribute to the stability of binocular vision. In the present study, three categories of visual perceptual detection indicators were used: binocular contrast balance, visual acuity measured with E0.8m and E1.5m, and stereoscopic measurement using striped patterns. These indicators facilitated a comprehensive quantitative assessment of binocular rivalry, integration, and overall binocular vision in children.

Following 3 months of visual perceptual training, reductions in binocular imbalance, improvements in binocular integration, and increased stereopsis were observed in participants. These findings align with the research conducted by Jiang and Meng, which indicates that enhancing binocular integration and rivalry functions may improve binocular vision, particularly in terms of stereoscopic perception (19).

Anisometropia is widely recognized as a factor impairing binocular vision and contributing to myopia progression, a relationship substantiated by multiple studies. Gawęcki et al., for example, induced myopic anisometropia in healthy individuals, finding that myopic refractive anisometropia between 3 and 4 D completely eliminated binocular vision at near distances. Furthermore, anisometropia of 2 D or greater significantly impaired binocular vision at far distances (20). Similarly, research conducted by Xiang and Du, which examined the refractive parameters, stereopsis, and accommodative function of 106 individuals, demonstrated that anisometropia can disrupt binocular accommodative function and overall binocular vision, potentially accelerating the progression of anisometropia or bilateral myopia (21).

In the visual perceptual training group in this study, binocular imbalance in visual perceptual function was observed, although baseline flexibility of accommodation remained below normal levels, and the difference in flexibility between the two eyes was not statistically significant. Post-training, the group exhibited an increase in accommodation flexibility and a decrease in binocular flexibility, though these changes did not reach statistical significance (P=0.12). It is speculated that the absence of targeted inclusion of participants with anisometropia in the visual perceptual training group may account for this finding, indicating an area for improvement in future studies.

Limitations of this study

This study has several limitations that should be acknowledged. First, the duration of the study was limited to three months, which may have constrained the ability to observe significant differences in axial length among the groups. Follow-up feedback indicated that primary reasons for reluctance to continue training by the participants included the length of the training sessions and the lack of engaging content. Future studies may consider exploring optimized training durations and enhancing program content to improve adherence. Additionally, the exclusion of participants who did not maintain adequate training intensity or timely follow-up may limit the generalizability of the findings, and the absence of subgroup analyses prevents the identification of optimal training intensity. Future research will need to address these limitations to refine training protocols and improve outcomes.

Conclusions

This study demonstrates that binocular visual perceptual training using naked-eye 3D technology effectively decelerates myopia progression and enhances binocular vision. Participants showed significant improvements in accommodative flexibility, indicating that this innovative training approach may serve as a valuable intervention for managing myopia and promoting healthier visual function in children. This study demonstrates that binocular visual perception training using naked-eye 3D technology can effectively control the further increase in the equivalent spherical refractive error of myopic patients in the short term, while improving their binocular vision and enhancing accommodative flexibility. However, its effect on controlling axial elongation requires longer-term observation.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the TREND statement checklist. Available at https://tp.amegroups.com/article/view/10.21037/tp-2024-523/rc

Data Sharing Statement: Available at https://tp.amegroups.com/article/view/10.21037/tp-2024-523/dss

Peer Review File: Available at https://tp.amegroups.com/article/view/10.21037/tp-2024-523/prf

Funding: This study was supported by the Shenzhen Science and Technology Innovation Commission Sustainable Development Project (Nos. KCXFZ20211020163814021 and KCXFZ20230731100700002), Sanming Project of Medicine in Shenzhen (No. SZZYSM202411007).

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-2024-523/coif). H.C. is employed by the Hunan Aoshi Medical Technology Co., Ltd. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. This study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments and was approved by the Ethics Committee of Shenzhen Eye Hospital (No. 2022KYPJ059). Written informed consent was obtained from the minor(s)’ legal guardian for the publication of any potentially identifiable images or data included in this article.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Holden BA, Fricke TR, Wilson DA, et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology 2016;123:1036-42. [Crossref] [PubMed]
2. Dong YH, Liu HB, Wang ZH, et al. Prevalence of myopia and increase trend in children and adolescents aged 7-18 years in Han ethnic group in China, 2005-2014. Zhonghua Liu Xing Bing Xue Za Zhi 2017;38:583-7. [PubMed]
3. Chen J, He XG, Wang JJ, et al. Forcasting the prevalence of myopia among students aged 6-18 years in China from 2021 to 2030. Zhonghua Yan Ke Za Zhi 2021;57:261-7. [PubMed]
4. Sankaridurg PR, Holden BA. Practical applications to modify and control the development of ametropia. Eye (Lond) 2014;28:134-41. [Crossref] [PubMed]
5. Chua SY, Sabanayagam C, Cheung YB, et al. Age of onset of myopia predicts risk of high myopia in later childhood in myopic Singapore children. Ophthalmic Physiol Opt 2016;36:388-94. [Crossref] [PubMed]
6. Sng CC, Lin XY, Gazzard G, et al. Peripheral refraction and refractive error in singapore chinese children. Invest Ophthalmol Vis Sci 2011;52:1181-90. [Crossref] [PubMed]
7. Lin ZH, Tao ZY, Kang ZF, et al. A Study on the Effectiveness of 650-nm Red-Light Feeding Instruments in the Control of Myopia. Ophthalmic Res 2023;66:664-71. [Crossref] [PubMed]
8. Li FF, Kam KW, Zhang Y, et al. Differential Effects on Ocular Biometrics by 0.05%, 0.025%, and 0.01% Atropine: Low-Concentration Atropine for Myopia Progression Study. Ophthalmology 2020;127:1603-11. [Crossref] [PubMed]
9. Jonas JB, Ohno-Matsui K, Panda-Jonas S. Myopia: Anatomic Changes and Consequences for Its Etiology. Asia Pac J Ophthalmol (Phila) 2019;8:355-9. [Crossref] [PubMed]
10. Logan NS, Radhakrishnan H, Cruickshank FE, et al. IMI Accommodation and Binocular Vision in Myopia Development and Progression. Invest Ophthalmol Vis Sci 2021;62:4. [Crossref] [PubMed]
11. Poudel S, Jin J, Rahimi-Nasrabadi H, et al. Contrast Sensitivity of ON and OFF Human Retinal Pathways in Myopia. J Neurosci 2024;44:e1487232023. [Crossref] [PubMed]
12. Tao Z, Deng H, Chu H, et al. Exploring the Relationship Between Binocular Imbalance and Myopia: Refraction with a Virtual Reality Platform. Cyberpsychol Behav Soc Netw 2022;25:672-7. [Crossref] [PubMed]
13. Yang X, Fan Y, Chu H, et al. Preliminary Study of Short-Term Visual Perceptual Training Based on Virtual Reality and Augmented Reality in Postoperative Strabismic Patients. Cyberpsychol Behav Soc Netw 2022;25:465-70. [Crossref] [PubMed]
14. Bennett CR, Bex PJ, Bauer CM, et al. The Assessment of Visual Function and Functional Vision. Semin Pediatr Neurol 2019;31:30-40. [Crossref] [PubMed]
15. Lai FTT, Huang L, Chui CSL, et al. Multimorbidity and adverse events of special interest associated with Covid-19 vaccines in Hong Kong. Nat Commun 2022;13:411. [Crossref] [PubMed]
16. Xie R, Zhao F, Yu J, et al. Naked-Eye 3-Dimensional Vision Training for Myopia Control: A Randomized Clinical Trial. JAMA Pediatr 2024;178:533-9. [Crossref] [PubMed]
17. Huang Y, Li M, Shen Y, et al. Study of the Immediate Effects of Autostereoscopic 3D Visual Training on the Accommodative Functions of Myopes. Invest Ophthalmol Vis Sci 2022;63:9. [Crossref] [PubMed]
18. Vera-Diaz FA, Bex PJ, Ferreira A, et al. Binocular temporal visual processing in myopia. J Vis 2018;18:17. [Crossref] [PubMed]
19. Jiang R, Meng M. Integration and suppression interact in binocular vision. J Vis 2023;23:17. [Crossref] [PubMed]
20. Gawęcki M. Threshold Values of Myopic Anisometropia Causing Loss of Stereopsis. J Ophthalmol 2019;2019:2654170. [Crossref] [PubMed]
21. Xiang A, Du K, Fu Q, et al. Do monocular myopia children need to wear glasses? Effects of monocular myopia on visual function and binocular balance. Front Neurosci 2023;17:1135991. [Crossref] [PubMed]