{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T18:13:58Z","timestamp":1777486438401,"version":"3.51.4"},"reference-count":43,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2023,5,15]],"date-time":"2023-05-15T00:00:00Z","timestamp":1684108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ophthalmic Physiologic Optic"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Recent evidence suggests that the ciliary muscle apical fibres are most responsive to accommodative load; however, the structure of the ciliary muscle in individuals with accommodative insufficiency is unknown. This study examined ciliary muscle structure in individuals with accommodative insufficiency (AI). We also determined the response of the ciliary muscle to accommodative\/vergence therapy and increasing accommodative demands to investigate the muscle's responsiveness to workload.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Subjects with AI were enrolled and matched by age and refractive error with subjects enrolled in another ciliary muscle study as controls. Anterior segment optical coherence tomography was used to measure the ciliary muscle thickness (CMT) at rest (0D), maximum thickness (CMTMAX) and over the area from 0.75\u2009mm (CMT0.75) to 3\u2009mm (CMT3) posterior to the scleral spur of the right eye. For those with AI, the ciliary muscle was also measured at increasing levels of accommodative demand (2D, 4D and 6D), both before and after accommodative\/vergence therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sixteen subjects with AI (mean age\u2009=\u200917.4\u2009years, SD\u2009=\u20098.0) were matched with 48 controls (mean age\u2009=\u200917.8\u2009years, SD\u2009=\u20098.2). On average, the controls had 52\u201372\u2009\u03bcm thicker ciliary muscles in the apical region at 0D than those with AI (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03 for both CMTMAX and CMT 0.75). Differences in thickness between the groups in other regions of the muscle were not statistically significant. After 8\u2009weeks of accommodative\/vergence therapy, the CMT increased by an average of 22\u201342\u2009\u03bcm (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009\u2264\u20090.04 for all), while AA increased by 7D (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study demonstrated significantly thinner apical ciliary muscle thickness in those with AI and that the ciliary muscle can thicken in response to increased workload. This may explain the mechanism for improvement in signs and symptoms with accommodative\/vergence therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/opo.13155","type":"journal-article","created":{"date-parts":[[2023,5,15]],"date-time":"2023-05-15T08:00:33Z","timestamp":1684137633000},"page":"947-953","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Impact of accommodative insufficiency and accommodative\/vergence therapy on ciliary muscle thickness in the eye"],"prefix":"10.1007","volume":"43","author":[{"given":"Emmanuel","family":"Owusu","sequence":"first","affiliation":[{"name":"College of Optometry The Ohio State University  Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nahrain M.","family":"Shasteen","sequence":"additional","affiliation":[{"name":"College of Optometry The Ohio State University  Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2557-2422","authenticated-orcid":false,"given":"G. Lynn","family":"Mitchell","sequence":"additional","affiliation":[{"name":"College of Optometry The Ohio State University  Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6947-9644","authenticated-orcid":false,"given":"Melissa D.","family":"Bailey","sequence":"additional","affiliation":[{"name":"College of Optometry The Ohio State University  Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3082-4943","authenticated-orcid":false,"given":"Chiu\u2010Yen","family":"Kao","sequence":"additional","affiliation":[{"name":"Department of Mathematical Sciences Claremont McKenna College  Claremont California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew J.","family":"Toole","sequence":"additional","affiliation":[{"name":"College of Optometry The Ohio State University  Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn","family":"Richdale","sequence":"additional","affiliation":[{"name":"College of Optometry The Ohio State University  Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0486-6998","authenticated-orcid":false,"given":"Marjean T.","family":"Kulp","sequence":"additional","affiliation":[{"name":"College of Optometry The Ohio State University  Columbus Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,5,15]]},"reference":[{"key":"e_1_2_9_2_1","first-page":"560","article-title":"General binocular dysfunctions in an urban optometry clinic","volume":"56","author":"Hokoda SC","year":"1985","journal-title":"J Am Optom Assoc"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00140808"},{"key":"e_1_2_9_4_1","first-page":"193","article-title":"Prevalence of vision and ocular disease conditions in a clinical pediatric population","volume":"67","author":"Scheiman M","year":"1996","journal-title":"J Am Optom Assoc"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1475-1313.2001.00540.x"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.3109\/09286586.2016.1155715"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tjo.2015.07.005"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006324-199702000-00023"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00417-008-0921-5"},{"key":"e_1_2_9_10_1","first-page":"239","article-title":"Predicting accommodative insufficiency and academic problems using the Conlon visual discomfort survey","volume":"40","author":"Chase C","year":"2009","journal-title":"Optom Vis Dev"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006324-200209000-00013"},{"key":"e_1_2_9_12_1","first-page":"25","article-title":"Association of symptoms and convergence and accommodative insufficiency in school\u2010age children","volume":"74","author":"Borsting E","year":"2003","journal-title":"Optometry"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.opx.0000216097.78951.7b"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1155\/2016\/6963976"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/opo.12911"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/opo.12747"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/OPX.0b013e31822f4d7c"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006324-199302000-00009"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.optm.2009.06.011"},{"issue":"3","key":"e_1_2_9_20_1","first-page":"634","article-title":"An attempt to determine the normal range of accommodation at various ages, being a revision of Donders' experiments","volume":"11","author":"Duane A","year":"1908","journal-title":"Trans Am Ophthalmol Soc"},{"issue":"1","key":"e_1_2_9_21_1","first-page":"386","article-title":"Anomalies of the accommodation clinically considered","volume":"14","author":"Duane A","year":"1915","journal-title":"Trans Am Ophthalmol Soc"},{"key":"e_1_2_9_22_1","first-page":"132","article-title":"Studies in monocular and binocular accommodation, with their clinical application","volume":"20","author":"Duane A","year":"1922","journal-title":"Trans Am Ophthalmol Soc"},{"key":"e_1_2_9_23_1","first-page":"159","article-title":"Subnormal accommodation","volume":"23","author":"Duane A","year":"1925","journal-title":"Trans Am Ophthalmol Soc"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006324-197905000-00002"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006324-198706000-00006"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006324-200106000-00014"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/OPX.0b013e318252cadc"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.08-2008"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.13-11658"},{"key":"e_1_2_9_30_1","volume-title":"Clinical management of binocular vision: heterophoric, accommodative, and eye movement disorders","author":"Scheiman M","year":"2019"},{"key":"e_1_2_9_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/OPX.0b013e31822f4d7c"},{"key":"e_1_2_9_32_1","doi-asserted-by":"publisher","DOI":"10.1080\/09286580701772037"},{"key":"e_1_2_9_33_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006324-193001000-00001"},{"key":"e_1_2_9_34_1","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.10-5787"},{"key":"e_1_2_9_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2005.01.047"},{"key":"e_1_2_9_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/opo.12039"},{"key":"e_1_2_9_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/OPX.0000000000000070"},{"key":"e_1_2_9_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/OPX.0b013e3182044b94"},{"key":"e_1_2_9_39_1","first-page":"270","article-title":"Effectiveness of therapy for the treatment of accommodative insufficiency: an open pilot study","volume":"7","author":"Shasteen NM","year":"2021","journal-title":"Vis Dev Rehab"},{"key":"e_1_2_9_40_1","doi-asserted-by":"publisher","DOI":"10.1097\/OPX.0b013e318253de7e"},{"key":"e_1_2_9_41_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0029(19960401)33:5<390::AID-JEMT2>3.0.CO;2-S"},{"key":"e_1_2_9_42_1","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.10-6447"},{"key":"e_1_2_9_43_1","doi-asserted-by":"publisher","DOI":"10.1097\/OPX.0000000000000402"},{"key":"e_1_2_9_44_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001648-199001000-00010"}],"container-title":["Ophthalmic and Physiological Optics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/opo.13155","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T11:23:48Z","timestamp":1767785028000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/opo.13155"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,15]]},"references-count":43,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2023,9]]}},"alternative-id":["10.1111\/opo.13155"],"URL":"https:\/\/doi.org\/10.1111\/opo.13155","archive":["Portico"],"relation":{},"ISSN":["0275-5408","1475-1313"],"issn-type":[{"value":"0275-5408","type":"print"},{"value":"1475-1313","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,15]]},"assertion":[{"value":"2022-08-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-04-16","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-15","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}