This study aimed to compare the efficacy of myopia control in adolescents wearing orthokeratology lenses (OKL) or single-vision spectacles (SVS). This prospective study included 30 myopic adolescents wearing orthokeratology lenses (OKL group) and 30 wearing SVS (SVS group). To prevent pseudo-replication arising from the strong correlation between fellow eyes, only right-eye data were analyzed, except for binocular tests requiring measurements from both eyes. All participants underwent assessments of visual acuity (VA), refraction, axial length (AL), and binocular visual function, including accommodative response, accommodative amplitude, distance and near heterophoria, gradient accommodative convergence/accommodation (AC/A) ratio, and horizontal fusional vergence. Binocular function was evaluated at baseline and at 1, 3, and 6 months, while VA, refraction, and AL were measured at baseline, 1 week, and 1, 3, 6, and 12 months. At 12 months, AL progression was more severe in the SVS group than in the OKL group (P < .05). OKL improved uncorrected visual acuity to about -0.05 within 1 month and maintained stability, whereas SVS vision declined by 6 months. Best-corrected distance visual acuity improved markedly in the OKL group but only modestly in the SVS group. OKL rapidly corrected spherical equivalent refraction and reduced accommodative lag, with no group differences in accommodative amplitude. OKL effectively slowed axial elongation, improved VA, and reduced accommodative lag in myopic adolescents, demonstrating superior myopia-control efficacy compared with SVS.

Background/Objectives: Low-dose atropine eye drops are widely used to slow myopia progression in children, but by reducing accommodation they may affect near ocular alignment and binocular visual function. Evidence on ocular alignment and strabismus-related findings remains insufficiently synthesized. This review examined low-dose atropine for pediatric myopia control in relation to ocular alignment and strabismus-related findings. Methods: PubMed/MEDLINE and Web of Science Core Collection were searched from inception to 16 April 2026. English-language studies addressing low-dose atropine, myopia control, ocular alignment, strabismus, binocular vision, accommodation, and vergence were screened. Of 247 records, 166 underwent screening after duplicate removal. Twenty-three database-derived and four manually identified full-text articles were reviewed. Eleven studies were included. Results: Of eleven included studies, six were clinical or interventional studies and five were case reports or case series. Case-based reports described near-predominant esodeviation, convergence excess-type deviation, elevated accommodative convergence/accommodation (AC/A) ratios, diplopia, reduced fusion, and acquired esotropia during fixed low-dose or escalating atropine use; most fixed low-dose cases improved after discontinuation or treatment modification. Clinical and interventional studies did not show consistent worsening of ocular alignment, near point of convergence (NPC), fusional vergence, or binocular vision. More consistent changes included pupil dilation, receded near point of accommodation (NPA), reduced accommodative amplitude and facility, selected fusional vergence changes, and short-term binocular or accommodative fluctuations. Conclusions: Low-dose atropine appears to be useful for pediatric myopia control and is generally well tolerated. However, selected cases may be temporally associated with ocular alignment abnormalities or strabismus-related findings. Careful monitoring may be warranted in children with unstable binocular systems and during dose escalation.

ObjectiveTo delineate a clinically actionable phenotype of consecutive esotropia with V-pattern following surgery for intermittent exotropia and to determine whether the initial surgical approach-bilateral lateral rectus recession versus unilateral recession-resection-is associated with differential patterns of V-pattern presentation and accommodative convergence/accommodation behavior among patients who develop consecutive esotropia. Clarifying these associations may inform postoperative surveillance and the selection of secondary surgical strategies in consecutive esotropia complicated by pattern deviation.MethodsWe retrospectively reviewed patients who developed consecutive esotropia after surgery for intermittent exotropia and were evaluated/managed at our center between 2016 and 2024. Thirty-four patients with consecutive esotropia had previously undergone bilateral lateral rectus recession (bilateral lateral rectus recession group), and twenty-six had previously undergone recession-resection (recession-resection group). Intermittent exotropia stage and consecutive esotropia clinical data were extracted, including ocular motility (with emphasis on abduction limitation), refractive status, presence and magnitude of V-pattern, and accommodative convergence/accommodation ratio measured using the gradient method. Comparisons were performed between groups at each stage and within individuals across the intermittent exotropia-to-consecutive esotropia transition.ResultsBaseline distance exodeviation was comparable between groups (bilateral lateral rectus recession: 38.92 ± 12.78Δ at 6 m and 36.47 ± 13.47Δ at 33 cm; recession-resection: 39.04 ± 12.91Δ at 6 m and 40.60 ± 10.54Δ at 33 cm), whereas near exodeviation was greater in the recession-resection group than in the bilateral lateral rectus recession group. No patient demonstrated a preoperative pattern deviation. Among consecutive esotropia cases, V-pattern was observed more frequently in the bilateral lateral rectus recession-derived consecutive esotropia cohort than in the recession-resection-derived cohort (15/34 vs. 3/26). During intermittent exotropia stage, accommodative convergence/accommodation ratios did not differ between groups; however, accommodative convergence/accommodation ratios increased after consecutive esotropia onset and were higher in the bilateral lateral rectus recession-derived consecutive esotropia cohort than in the recession-resection-derived cohort. These findings indicate that, once consecutive esotropia develops, the postoperative phenotype may vary according to initial procedure, with a stronger association between bilateral lateral rectus recession-derived consecutive esotropia and both V-pattern presentation and elevated accommodative convergence/accommodation.ConclusionsAmong patients who developed consecutive esotropia after intermittent exotropia surgery, bilateral lateral rectus recession-derived consecutive esotropia was more commonly accompanied by V-pattern and a higher accommodative convergence/accommodation ratio than recession-resection-derived consecutive esotropia. The increase in accommodative convergence/accommodation from the intermittent exotropia stage to the consecutive esotropia stage suggests that accommodative mechanisms may contribute to the consecutive esotropia-with-pattern phenotype and should be assessed when planning postoperative monitoring and secondary correction. Importantly, this study characterizes phenotypic differences among consecutive esotropia cases and does not estimate the incidence of consecutive esotropia or V-pattern consecutive esotropia after bilateral lateral rectus recession or recession-resection.

To propose which tests may be used for diagnosing convergence excess. A prospective study of a consecutive clinical sample was performed. Patients (18-35 years) attending optometric care underwent subjective refraction, cover test, and Symptom Questionnaire for Visual Dysfunctions (SQVD). Based on cover test and SQVD scores, two groups were recruited: 64 symptomatic subjects with near esophoria and 64 asymptomatic with normal binocular vision. Accommodative and binocular tests were assessed, identifying those with significant statistical differences between groups. Diagnostic validity was analysed using ROC curves, sensitivity, specificity, and likelihood ratios. A serial testing strategy combining tests was also evaluated. ROC analysis showed best diagnostic accuracy for binocular accommodative facility (BAF) failing with -2.00 D (area under the curve, AUC = 0.865) and vergence facility (VF) failing with base-in prisms (AUC = 0.864). Using cutoffs from ROC analysis (BAF: ≤8.25 cpm and VF ≤ 12.75 cpm), their combination showed best validity (S = 0.625, Sp = 0.938, LR+ = 10, LR- = 0.4). The combined AUC was 0.932. The proposal for diagnosing convergence excess is to use, in addition to near esophoria with normal distance heterophoria, the combination of failing BAF with negative lenses and failing vergence facility with base-in prisms.

The syndromic convergence of septic shock and acute respiratory distress syndrome represents a critical nexus of pathophysiological complexity, marked by profoundly elevated mortality and governed by multifaceted, temporally dynamic cardiorespiratory interactions. Conventional hemodynamic management paradigms frequently fail to achieve optimal outcomes, owing to their insufficient accommodation of the bidirectional and nonlinear interdependence between respiratory system derangements and cardiovascular stress responses. This review systematically re-examines the underlying mechanistic architecture of these interactions, commencing with a reappraisal of the canonical Guyton model of circulatory equilibrium, followed by an in-depth delineation of the respiratory cycle's modulatory influence on cardiac preload, afterload, and ventricular interdependence. Central to the analysis is the contention that acute respiratory distress syndrome should be mechanistically phenotyped into "pulmonary" and "extra-pulmonary" subtypes, a nosological distinction with direct implications for divergent hemodynamic trajectories under mechanical ventilation. Emerging integrative models-synthesizing respiratory mechanics with advanced circulatory physiology-are presented to conceptualize and visualize these complex feedback loops. This framework converges upon the pivotal determinant of hemodynamic stability: the coupling ratio between right ventricular contractile performance, quantified by end-systolic elastance, and the imposed pulmonary arterial load, represented by effective arterial elastance. The overarching aim is to advance an integrative, mechanistically anchored, and clinically actionable schema capable of enhancing diagnostic granularity, guiding individualized hemodynamic optimization, and ultimately improving survival in this uniquely unstable and high-acuity patient cohort.

As an optical system, the eyes function in line with the basic principles of refraction. Visual clarity depends on the ability to bring incident light rays to a point focus at the fovea centralis. Schematically, the cornea and crystalline lens provide the requisite total dioptric power (about +60 diopters; the cornea makes up about + 40 to + 48 diopters). Accommodation is the adaptative faculty that enables clear vision with subjective variation in the linear distance of visual targets. This is accomplished by the autonomic adjustment of crystalline lens dioptric powers to provide focus on the presented stimuli. The main stimulus is 'blur.' The focusing powers of the crystalline lens are directly proportional to the increase or decrease in lens convexity. At the near point of accommodation, the ciliary muscles contract and relax zonular tension, thus enabling increased convexity and focusing power. For the far point of accommodation, the ciliary muscles relax and exert greater tension on the zonules (of Zinn), thus reducing lenticular convexity.  Under typical conditions, the healthy eye responds to near-point (linear) stimuli by activating the near triad, which includes accommodation, convergence, and miosis. These mechanisms are synergistically engaged to enable single, clear binocular vision. Inhibition in one of these reflexes can most likely lead to dysfunction of accommodative response. Concerning the near reflexes, accommodation and convergence are most closely intertwined. This interrelationship can be reported as the 'accommodative convergence to accommodation (AC/A)  ratio. Depending on the underlying accommodative dysfunction, the ac/a ratio may be either low, normal, or high. The accommodative mechanisms can be subject to functional anomalies in maintaining visual clarity. Based on the Duke-Elder classification, these include: Accommodative insufficiency (AI). Accommodative spasm. Accommodative inertia. Ill-sustained accommodation. Accommodative infacility. AI is a functional vision anomaly characterized by the inability to sustain focus at near. With this condition, the accommodative response is often suboptimal compared to expected normal ranges.

Low-dose atropine (LDA) is effective for slowing myopia progression and preventing its onset in children. It is generally considered safe. The main adverse effects are mild photophobia and blurred vision at near secondary to accommodative dysfunction. Esotropia is a rare adverse event that can occur in temporal association with LDA. We report a pediatric case of near-esotropia that emerged after the initiation of 0.025% low-dose atropine for myopia control and onset prevention and resolved after discontinuation; the longitudinal accommodative convergence-to-accommodation (AC/A) ratio assessments documented a transient elevation during treatment, with subsequent normalization off-therapy. To our knowledge, this is the first report documenting longitudinal AC/A ratio changes during and after low-dose atropine therapy.

» Chronic Charcot arthropathy results from the convergence of genetic predisposition (OPG/RANKL/RANK polymorphisms), metabolic disturbances (AGEs, vitamin D deficiency affecting 84.2% of patients), and inflammatory dysregulation (RANKL/OPG axis, IL-17 family cytokines), explaining why only 0.08-1% of diabetic neuropathy patients develop this devastating complication. » The receptor activator of nuclear factor kappa-B ligand (RANKL)/receptor activator of nuclear factor kappa-B (RANK)/osteoprotegerin (OPG) axis dysregulation drives excessive osteoclastogenesis and bone resorption in the acute phase, while impaired Wnt/β-catenin signaling and advanced glycation end products-modified collagen compromise healing quality in the chronic phase, resulting in malunion and permanent deformity. » Magnetic resonance imaging is the best non-invasive imaging modality for differentiating chronic Charcot from osteomyelitis (single bone involvement beneath ulcer, sinus tract, and abscess favor infection; periarticular distribution favors Charcot), though bone biopsy remains the gold standard when diagnostic uncertainty persists. » Current management relies primarily on mechanical interventions (accommodative footwear, bracing, surgical reconstruction for unbraceable deformities), but emerging molecular therapies targeting RANKL (denosumab), pro-inflammatory cytokines (IL-17 inhibitors), and Wnt pathway (romosozumab) show promise for disease modification. » Integrated risk stratification models combining genetic risk scores, serum biomarkers (RANKL/OPG ratio, vitamin D levels), and clinical factors can identify high-risk individuals (AUC 0.89), enabling targeted preventive interventions including vitamin D supplementation, prophylactic off-loading, and potentially pharmacological prevention.