Binocular Visual Function in Children Wearing Single-Vision or Highly Aspherical Lenslet Spectacle Lenses Assessed with a Tablet-Based Dichoptic Platform

Abstract

Purpose To evaluate multi-distance binocular visual function in children using a tablet-based dichoptic platform and compare performance between single-vision and highly aspherical lenslet (HAL) spectacle lenses. Methods This cross-sectional study included 300 children aged 4 to 17 years wearing single-vision spectacle lenses (n = 154) or HAL spectacle lenses (n = 146). Outcomes included foveal simultaneous-perception non-composite responses, peripheral simultaneous-perception non-normal responses, and fine, dynamic, and gross stereopsis from 0.4 to 3.0 m. Generalized estimating equations clustered by participant evaluated lens type and testing distance, with adjustment for age, sex, myopia magnitude, interocular spherical-equivalent difference, and mean absolute cylinder. Results Fine stereopsis declined significantly as testing distance increased and was rarely measurable at 2.0 m. Compared with 0.4 m, the adjusted odds of measurable fine stereopsis were lower at 1.5 m (adjusted odds ratio [aOR] = 0.81; P = 0.003) and 2.0 m (aOR = 0.08; P < 0.001). In adjusted observational analyses, HAL lens wear was associated with higher odds of measurable dynamic (aOR = 1.68; P = 0.024) and gross stereopsis (aOR = 2.51; P = 0.006) than single-vision lens wear. Fine stereopsis remained comparable between the two groups (aOR = 0.99; P = 0.960). Foveal non-composite responses were uncommon at 0.4 m but highly prevalent at 3.0 m (>87%) regardless of lens type, while peripheral simultaneous perception remained mostly normal. Conclusions Tablet-based binocular visual performance declined as the testing distance increased. In this cross-sectional observational analysis, children wearing HAL spectacle lenses showed higher adjusted odds of measurable dynamic and gross stereopsis than those wearing single-vision lenses, while fine stereopsis remained comparable. These findings provide preliminary clinical evidence regarding binocular visual performance with HAL lens wear and warrant confirmation in longitudinal studies across different myopia levels.